MEDICARE: JANAI RUCKER

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	363A00000X	Physician Assistant	PA1777	TX

General Provider Information

NPI Number	:	1225745755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANAI RUCKER

Provider Business Mailing Address
First Line	:	2323 N CENTRAL EXPY
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 E STACY RD STE 160
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-8856
Country	:	US
Telephone Number	:	214-491-1775
Fax Number	:	214-491-1699

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

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	01/23/2026

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Directions to “ JANAI RUCKER ” Practice Location

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