Modrall, Jamie K

Modrall, Jamie K is an individual health care provider with primary practice located at 18601 Lyndon B Johnson Fwy Ste 315 , Mesquite TX 75150-5612. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Modrall, Jamie K can be contacted via phone (972) 686-1795.

Contact Information

Primary practice address
18601 Lyndon B Johnson Fwy Ste 315 Mesquite TX 75150-5612
Phone: (972) 686-1795
Fax: (972) 686-1798
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 650239 Texas

Profile Details

NPI number 1336169002
LBN Legal business name Modrall, Jamie K
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Nov 7th, 2012 - about 13 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 1336169002 NPPES
Texas MEDICAID 041477302
Texas MEDICAID 041477304

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