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Individual

JACLYN THERESA CHANNELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AGACNP

Contact information

Practice address
221 W COLORADO BLVD STE 525, DALLAS, TX 75208-2312
(214) 956-4525
(214) 960-5681
Mailing address
5264 KATY ROSE CT, FORT WORTH, TX 76126-3053
(817) 907-9467

Taxonomy

Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
792582
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
AP145190
TX
363LG0600X
Gerontology Nurse Practitioner
AP145190
TX

Other

Enumeration date
02/20/2020
Last updated
03/26/2024
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