Hataway, Jeremy Scott

Hataway, Jeremy Scott is an sole proprietor health care provider with primary practice located at 4560 Lake Ridge Pkwy Ste 110 , Grand Prairie TX 75052-1707. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Hataway, Jeremy Scott can be contacted via phone (972) 522-7778.

Contact Information

Primary practice address
4560 Lake Ridge Pkwy Ste 110 Grand Prairie TX 75052-1707
Phone: (972) 522-7778
Fax: (972) 522-7779
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 5004212 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 670631 Texas

Profile Details

NPI number 1528203155
LBN Legal business name Hataway, Jeremy Scott
Credentials FNP-BC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 11th, 2008
Last updated Oct 6th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528203155 NPPES
Texas Other 670631 NP LICENSE

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