Provider Demographics
NPI:1932559929
Name:IRSULA PACHECO, JESUS ISMAEL
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ISMAEL
Last Name:IRSULA PACHECO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12377 MERIT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3126
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:
Practice Address - Street 1:3434 W ILLINOIS AVE STE 306
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-8813
Practice Address - Country:US
Practice Address - Phone:214-623-1900
Practice Address - Fax:214-623-1901
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10869057363LF0000X
TX1089057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty