Jacey Cardwell, | |
2350 N Stemmons Fwy, Dallas, TX 75207-2700 | |
(214) 662-1738 | |
Not Available |
Full Name | Jacey Cardwell |
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Gender | Female |
Speciality | Dietitian, Registered |
Location | 2350 N Stemmons Fwy, Dallas, Texas |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1568018000 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | DT82679 (Texas) | Primary |
Provider Name | Phoenix Children's Hospital |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1922112044 PECOS PAC ID: 0446278584 Enrollment ID: O20051107000704 |
Mailing Address | Practice Location Address |
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Jacey Cardwell, 6711 Pimlico Dr, Dallas, TX 75214-1655 Ph: () - | Jacey Cardwell, 2350 N Stemmons Fwy, Dallas, TX 75207-2700 Ph: (214) 662-1738 |
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