Provider Demographics
NPI:1285060640
Name:GREGORY, JACKIE SUE (FNP)
Entity type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:SUE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8426 FALCONET CIR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5821
Mailing Address - Country:US
Mailing Address - Phone:214-289-2814
Mailing Address - Fax:
Practice Address - Street 1:1250 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BUILDING III SUITE 380
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6446
Practice Address - Country:US
Practice Address - Phone:512-330-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX554539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily