Provider Demographics
NPI:1790784494
Name:LOUCK, JANICE M (MSN, RNCS, FNP)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:M
Last Name:LOUCK
Suffix:
Gender:F
Credentials:MSN, RNCS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 TREETOP TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3845
Mailing Address - Country:US
Mailing Address - Phone:817-319-1177
Mailing Address - Fax:817-557-0699
Practice Address - Street 1:1301 W 7TH ST
Practice Address - Street 2:SUITE 121
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-2651
Practice Address - Country:US
Practice Address - Phone:817-348-0425
Practice Address - Fax:817-348-0455
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092888910Medicaid
TX092888909Medicaid
TXS88900Medicare UPIN
TX8F2351Medicare PIN
TX092888910Medicaid