MEDICARE: MRS. JACQUELYN STELLA JOHNSON FNP

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	F06230198	TX
2	163WE0003X	Emergency Registered Nurse	948039	TX

General Provider Information

NPI Number	:	1609569714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELYN STELLA JOHNSON FNP

Provider Business Mailing Address
First Line	:	8501 FM 407
Second Line	:
City	:	DOUBLE OAK
State	:	TX
Zip	:	75077-3031
Country	:	US
Telephone Number	:	972-966-1980
Fax Number	:	972-691-4937

Provider Business Practice Location Address
First Line	:	3305 GASTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2014
Country	:	US
Telephone Number	:	214-820-0317
Fax Number	:

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

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	12/04/2025

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Directions to “ MRS. JACQUELYN STELLA JOHNSON FNP” Practice Location

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