Provider Demographics
NPI:1538764949
Name:MOFFETT-PRINCE, JONELL
Entity type:Individual
Prefix:
First Name:JONELL
Middle Name:
Last Name:MOFFETT-PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JONELL
Other - Middle Name:
Other - Last Name:MOFFETT-PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1114 HUTCHINS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-3730
Mailing Address - Country:US
Mailing Address - Phone:469-450-8831
Mailing Address - Fax:
Practice Address - Street 1:1114 HUTCHINS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-3730
Practice Address - Country:US
Practice Address - Phone:469-450-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker