Provider Demographics
NPI:1508698309
Name:POWELL, JOY RENEE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:RENEE
Last Name:POWELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4611
Mailing Address - Country:US
Mailing Address - Phone:817-759-7000
Mailing Address - Fax:817-759-7000
Practice Address - Street 1:7415 LAS COLINAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7569
Practice Address - Country:US
Practice Address - Phone:214-379-2700
Practice Address - Fax:972-869-3875
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP1171195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily