Provider Demographics
NPI:1417928953
Name:NURSE PRACTITIONERS GROUP OF CORPUS CHRISTI
Entity Type:Organization
Organization Name:NURSE PRACTITIONERS GROUP OF CORPUS CHRISTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP MSN
Authorized Official - Phone:361-985-1221
Mailing Address - Street 1:PO BOX 6696
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466
Mailing Address - Country:US
Mailing Address - Phone:361-985-1221
Mailing Address - Fax:361-985-1295
Practice Address - Street 1:4444 CORONA DR STE 137
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4323
Practice Address - Country:US
Practice Address - Phone:361-985-1221
Practice Address - Fax:361-985-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141568901Medicaid