Provider Demographics
NPI:1437712155
Name:JOHN, MERCY
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4202
Mailing Address - Country:US
Mailing Address - Phone:972-230-8881
Mailing Address - Fax:972-230-8810
Practice Address - Street 1:333 N SHILOH RD STE 170
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6680
Practice Address - Country:US
Practice Address - Phone:972-810-8599
Practice Address - Fax:833-992-1979
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX754525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily