Provider Demographics
NPI:1235395732
Name:SELF, RACHEL LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEE
Last Name:SELF
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LEE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:2133 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4108
Mailing Address - Country:US
Mailing Address - Phone:469-305-8057
Mailing Address - Fax:
Practice Address - Street 1:2133 GREENVIEW DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4108
Practice Address - Country:US
Practice Address - Phone:469-305-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640626163WP0808X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211222901Medicaid
TXP00860920OtherRAILROAD
TX211222902Medicaid
TX818N21OtherBCBS
TX818N21OtherBCBS
TXP00860920OtherRAILROAD