MEDICARE: NEIGHBORHOOD HOUSE CALLS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1083388243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORHOOD HOUSE CALLS PLLC

Provider Business Mailing Address
First Line	:	2321 LAUREL FOREST DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-3538
Country	:	US
Telephone Number	:	254-231-5793
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 LAUREL FOREST DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-3538
Country	:	US
Telephone Number	:	254-231-5793
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TOMMORA JACKSON
Credential	:
Telephone Number	:	254-231-5793

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

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