Provider Demographics
NPI:1083786040
Name:DONNELLY, PATRICK MICHAEL (FNP)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 BRUTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-2704
Mailing Address - Country:US
Mailing Address - Phone:972-288-2844
Mailing Address - Fax:972-288-2859
Practice Address - Street 1:9709 BRUTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-2704
Practice Address - Country:US
Practice Address - Phone:972-288-2844
Practice Address - Fax:972-288-2859
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX790443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily