Provider Demographics
NPI:1558801191
Name:RICH, JACI (MSN, RN, CFNP)
Entity Type:Individual
Prefix:
First Name:JACI
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:MSN, RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 SANTA ROSA DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2260
Mailing Address - Country:US
Mailing Address - Phone:432-233-1965
Mailing Address - Fax:
Practice Address - Street 1:4517 SANTA ROSA DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2260
Practice Address - Country:US
Practice Address - Phone:432-233-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily