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5454 Surrey Path Ste 201 Frisco TX 75034-9582 | |
| (469) 200-0117 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 5454 Surrey Path Ste 201, Frisco, Texas |
| Authorized Official Name and Position | Jenessa Mckray (OWNER) |
| Authorized Official Contact | 4699602909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2829 Sheridan Dr Carrollton TX 75010-4270 Ph: () - | 5454 Surrey Path Ste 201 Frisco TX 75034-9582 Ph: (469) 200-0117 |
| NPI Number | 1356117097 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 07/02/2024 |
| Medicare PECOS PAC ID | 4587003827 |
|---|---|
| Medicare Enrollment ID | O20240418003084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356117097 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Jenessa M Mckray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548631195 PECOS PAC ID: 7416241682 Enrollment ID: I20160810002453 |
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