MEDICARE: JANNINE PURCELL

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	363L00000X	Nurse Practitioner	0327	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01635758	OTHER	TX	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75-2616977--008	OTHER	TX	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8979NU	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1184660086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNINE PURCELL

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 E HOUSTON ST STE 550
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-8366
Country	:	US
Telephone Number	:	903-510-8718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	08/12/2016

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Directions to “ JANNINE PURCELL ” Practice Location

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