Provider Demographics
NPI:1477893873
Name:BROCKER, JERI GRACE (FNP)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:GRACE
Last Name:BROCKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:GRACE
Other - Last Name:BROCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1000 PINE ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5100
Mailing Address - Country:US
Mailing Address - Phone:903-798-8000
Mailing Address - Fax:
Practice Address - Street 1:1000 PINE ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5100
Practice Address - Country:US
Practice Address - Phone:903-798-8000
Practice Address - Fax:615-846-3006
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX540942363LF0000X
TXAP121929363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297391YMJMMedicare PIN