Provider Demographics
NPI:1295796258
Name:SCHENKEL, MARY LYNN (RN FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:SCHENKEL
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:WATKINS
Other - Last Name:SCHENKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN FNP
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-8898
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-645-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX244738363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143559603Medicaid
P21884Medicare UPIN
TX143559603Medicaid