Provider Demographics
NPI:1902458516
Name:PRICE, JUANITA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:PRICE
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 1:4323 S HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-1058
Mailing Address - Country:US
Mailing Address - Phone:214-331-6534
Mailing Address - Fax:214-433-3046
Practice Address - Street 1:4323 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1058
Practice Address - Country:US
Practice Address - Phone:214-331-6534
Practice Address - Fax:214-433-3046
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily