Provider Demographics
NPI:1164895462
Name:MCCALLISTER, JANA LYNN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:LYNN
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:MCCALLISTER
Other - Last Name:PAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3801C CONSTITUTION
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922
Mailing Address - Country:US
Mailing Address - Phone:210-762-3682
Mailing Address - Fax:
Practice Address - Street 1:3801C CONSTITUTION
Practice Address - Street 2:SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922
Practice Address - Country:US
Practice Address - Phone:210-762-3682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily