Provider Demographics
NPI:1316438450
Name:RICE, JACKIE DENISE (LVN)
Entity type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:DENISE
Last Name:RICE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 TREE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-3822
Mailing Address - Country:US
Mailing Address - Phone:817-805-4535
Mailing Address - Fax:
Practice Address - Street 1:4504 TREE LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-3822
Practice Address - Country:US
Practice Address - Phone:817-805-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330013164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse