Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP126684 | TX |
NPI | 1033513031 |
---|---|
Provider Name | Jillian Adams |
First Address | Dallas, TX 75230-2571 |
Second Address | Dallas, TX 75230-2571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2014 |
Last Update Date | 20/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
697515 | LICENSE (01) | TX |
AP126684 | LICENSE (01) | TX |