1144849191 NPI number — JACEY ELIZABETH MONROE RN, APRN, PMHNP-BC

Table of content: JACEY ELIZABETH MONROE RN, APRN, PMHNP-BC (NPI 1144849191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144849191 NPI number — JACEY ELIZABETH MONROE RN, APRN, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONROE
Provider First Name:
JACEY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, APRN, PMHNP-BC
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:
1144849191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20044 FM 16 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDALE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75771-5519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-226-3987
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 ELDORADO PKWY STE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75070-3590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-893-3376
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2020

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: 163WC0200X , with the licence number:  887018 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X , with the licence number: 887018 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 1069770 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 1069770 , 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)

  • Identifier: 2021210051 . This is a "ANCC PMHNP-BC CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1069770 . This is a "ADVANCED PRACTICE REGISTERED NURSE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 887018 . This is a "REGISTERED NURSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".