MEDICARE: JACQUELINE DENISE COVELLI FNP-C

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	F09190701	TX
2	363L00000X	Nurse Practitioner	AP143412	TX

General Provider Information

NPI Number	:	1992356257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE DENISE COVELLI FNP-C

Provider Business Mailing Address
First Line	:	9921 WINDLAKE CIR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-2123
Country	:	US
Telephone Number	:	972-746-9963
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-2123
Country	:	US
Telephone Number	:	214-645-4673
Fax Number	:

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

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	11/21/2025

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