MEDICARE: RANELL RENEE' EARL NP

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	1167884	TX

General Provider Information

NPI Number	:	1407683113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANELL RENEE' EARL NP

Provider Business Mailing Address
First Line	:	3639 HOLMES ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-3605
Country	:	US
Telephone Number	:	972-354-8712
Fax Number	:

Provider Business Practice Location Address
First Line	:	3639 HOLMES ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-3605
Country	:	US
Telephone Number	:	972-354-8712
Fax Number	:

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

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	06/24/2026

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