MEDICARE: JAYMA LEE DEGROOT FNP-C

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	363LF0000X	Family Nurse Practitioner	628711	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396978243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYMA LEE DEGROOT FNP-C

Provider Business Mailing Address
First Line	:	304 ROCKETT LN
Second Line	:
City	:	RED OAK
State	:	TX
Zip	:	75154-7812
Country	:	US
Telephone Number	:	214-725-8173
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 MCKINNON ST
Second Line	:	SUITE 400
City	:	DALLAS
State	:	TX
Zip	:	75201-1044
Country	:	US
Telephone Number	:	214-754-8700
Fax Number	:	214-239-3769

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

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/15/2012

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