MEDICARE: MRS. JIJIMOL E JOHN 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	AP137154	TX

General Provider Information

NPI Number	:	1568947448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JIJIMOL E JOHN NP

Provider Business Mailing Address
First Line	:	2535 CHARLOTTE ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-3301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2535 CHARLOTTE ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-3301
Country	:	US
Telephone Number	:	940-566-1200
Fax Number	:

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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