Provider Demographics
NPI:1568016962
Name:JOSEPH, MARY (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E. GRUBB DR.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149
Mailing Address - Country:US
Mailing Address - Phone:972-285-6349
Mailing Address - Fax:972-289-6717
Practice Address - Street 1:125 E. GRUBB DR.
Practice Address - Street 2:SUITE 105
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:972-285-6349
Practice Address - Fax:972-289-6717
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily