Provider Demographics
NPI:1265261176
Name:PRACHT, JACQUELINE HOPE (FNP-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:HOPE
Last Name:PRACHT
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 1:2512 LAKECREST DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-3005
Mailing Address - Country:US
Mailing Address - Phone:318-519-7234
Mailing Address - Fax:
Practice Address - Street 1:8911 NORTH CAPITAL OF TEXAS HWY BLD 1 SUITE 1110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:877-279-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily