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NPI Code Detail

MEDICARE: MRS. JACQUELINE LURECE DAVIS RN, FNP

MEDICARE: MRS. JACQUELINE LURECE DAVIS RN, 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
1363LF0000XFamily Nurse Practitioner615946TX

General Provider Information

NPI Number : 1801220488
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACQUELINE LURECE DAVIS RN, FNP
Provider Business Mailing Address
First Line : 6309 FALLBROOK DR
Second Line :
City : GARLAND
State : TX
Zip : 75043-5920
Country : US
Telephone Number : 972-896-9501
Fax Number :
Provider Business Practice Location Address
First Line : 4432 MALCOLM X BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75215-4349
Country : US
Telephone Number : 214-428-2010
Fax Number : 214-428-2065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2013
Last Update Date : 08/30/2013

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