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Search › Texas › 363LF0000X

Jeremy Hataway, FNP-BC

NPI 1528203155 · on the registry since 2008 · sole proprietor

Practice

Address
4560 Lake Ridge Pkwy Ste 110
Grand Prairie, TX 75052
Phone
(972) 522-7778
Fax
(972) 522-7779
Organisation at this address
Medhealth
Medhealth
Medhealth
Inferred from a shared address, not stated in the registry.
Clinicians at this address
16

Registry record

Primary taxonomy
363LF0000X
363LF0000X
Also registered as
363LF0000X
Licence states on file
NC, TX
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2021-10-06

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Texas