MEDICARE: RACHEL JAISON

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	AP136920	TX

General Provider Information

NPI Number	:	1679059950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL JAISON

Provider Business Mailing Address
First Line	:	9900 N CENTRAL EXPY STE 225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-0918
Country	:	US
Telephone Number	:	469-646-8880
Fax Number	:	469-646-8884

Provider Business Practice Location Address
First Line	:	8210 WALNUT HILL LN STE 306
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4419
Country	:	US
Telephone Number	:	469-646-8880
Fax Number	:	469-646-8884

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

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	10/23/2019

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Directions to “ RACHEL JAISON ” Practice Location

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