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NPI Code Detail

MEDICARE: JAMIE L GULLY NP

MEDICARE: JAMIE L GULLY 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
1363LF0000XFamily Nurse Practitioner719772TX

General Provider Information

NPI Number : 1669736617
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE L GULLY NP
Provider Business Mailing Address
First Line : 3529 HERITAGE TRACE PKWY STE 137
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4971
Country : US
Telephone Number : 817-741-7960
Fax Number : 817-741-7581
Provider Business Practice Location Address
First Line : 3529 HERITAGE TRACE PKWY STE 137
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4971
Country : US
Telephone Number : 817-741-7960
Fax Number : 817-741-7581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2012
Last Update Date : 09/18/2012

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Directions to “ JAMIE L GULLY NP” Practice Location

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