Individual
JACKIE IJEOMA PENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5319 NUECES LN, GRAND PRAIRIE, TX 75052-2667
(214) 584-4103
Mailing address
5319 NUECES LN, GRAND PRAIRIE, TX 75052-2667
(214) 584-4103
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
783349
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1056737
TX
Other
Enumeration date
05/28/2013
Last updated
05/03/2024
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