Provider Demographics
NPI:1245816404
Name:JEONG, JAYOUNG (FNP-C)
Entity type:Individual
Prefix:
First Name:JAYOUNG
Middle Name:
Last Name:JEONG
Suffix:
Gender:F
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 1:2944 MOTLEY DR STE 401
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3464
Mailing Address - Country:US
Mailing Address - Phone:972-289-2273
Mailing Address - Fax:
Practice Address - Street 1:2944 MOTLEY DR STE 401
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3464
Practice Address - Country:US
Practice Address - Phone:972-289-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily