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Organization
J & J HEALTHCARE CLINIC
Active
Organization
J & J HEALTHCARE CLINIC
Active
Other names
J and J Healthcare Services
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL LAMONT JERIDEAU (NURSE PRACTITIONER)
(972) 780-0118
Entity
Organization
Contact information
Practice address
1459 ACTON AVE, DUNCANVILLE, TX 75137
(972) 780-0118
(972) 780-0491
Mailing address
1459 ACTON AVE, DUNCANVILLE, TX 75137
(972) 780-0118
(972) 780-0491
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
651668
TX
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165696902
—
TX
Enumeration date
07/14/2006
Last updated
07/18/2008
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