Provider Demographics
NPI:1194153742
Name:JERICHO FAMILY HEALTHCARE, PLLC
Entity type:Organization
Organization Name:JERICHO FAMILY HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TYRA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:972-542-5811
Mailing Address - Street 1:1505 HARROUN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3432
Mailing Address - Country:US
Mailing Address - Phone:972-542-5811
Mailing Address - Fax:972-542-5813
Practice Address - Street 1:1505 HARROUN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3432
Practice Address - Country:US
Practice Address - Phone:972-542-5811
Practice Address - Fax:972-542-5813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX584873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty