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NPI Code Detail

MEDICARE: JONETTA ERVINE

MEDICARE: JONETTA ERVINE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1568352961
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONETTA ERVINE
Provider Business Mailing Address
First Line : 5320 N TARRANT PKWY STE 250
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-5451
Country : US
Telephone Number : 682-900-1444
Fax Number :
Provider Business Practice Location Address
First Line : 5320 N TARRANT PKWY STE 250
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-5451
Country : US
Telephone Number : 682-900-1444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2025
Last Update Date : 07/07/2025

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Directions to “ JONETTA ERVINE ” Practice Location

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