1013057306 NPI number — MS. JOYCE MICHELLE HARRELL R.D., L.D., CDE

Table of content: MS. JOYCE MICHELLE HARRELL R.D., L.D., CDE (NPI 1013057306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013057306 NPI number — MS. JOYCE MICHELLE HARRELL R.D., L.D., CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRELL
Provider First Name:
JOYCE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.D., L.D., CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013057306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1408 SIMPSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76053-4031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-991-1805
Provider Business Mailing Address Fax Number:
817-571-5162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 WESTPARK WAY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
EULESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76040-3742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-868-6410
Provider Business Practice Location Address Fax Number:
817-571-5162
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DT04560 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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