Provider Demographics
NPI:1801806526
Name:PALECEK, MARY JOYCE (CFNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOYCE
Last Name:PALECEK
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JOYCE
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:3203 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7727
Practice Address - Country:US
Practice Address - Phone:903-882-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR48132363LF0000X
TX753449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8JA962OtherBCBS
TX632791YNSXOtherMEDICARE
TXP01999119OtherMCRR
NM69304718Medicaid