Provider Demographics
NPI:1932667813
Name:CREEK, JONATHAN DUANE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DUANE
Last Name:CREEK
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S GRAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2273
Mailing Address - Country:US
Mailing Address - Phone:972-938-0100
Mailing Address - Fax:972-937-9073
Practice Address - Street 1:120 S GRAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2273
Practice Address - Country:US
Practice Address - Phone:972-938-0100
Practice Address - Fax:972-937-9073
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140762363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP140762OtherAPRN
TX29397OtherRX AUTHORIZATION NUMBER