MEDICARE: JOEL FARRIS AGNP

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	363LG0600X	Gerontology Nurse Practitioner	AG08180098	TX

General Provider Information

NPI Number	:	1487133021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL FARRIS AGNP

Provider Business Mailing Address
First Line	:	5440 HARVEST HILL RD STE 182
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 HARVEST HILL RD STE 182
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1605
Country	:	US
Telephone Number	:	214-213-4726
Fax Number	:

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

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	03/12/2019

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