Basic Information
| Provider Information | |||||||||
| NPI: | 1144849191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONROE | ||||||||
| FirstName: | JACEY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | RN, APRN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20044 FM 16 W | ||||||||
| Address2: | |||||||||
| City: | LINDALE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757715519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692263987 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7300 ELDORADO PKWY STE 225 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750703590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728933376 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 887018 | TX | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 163WH0200X | 887018 | TX | N | Nursing Service Providers | Registered Nurse | Home Health | 363LP0808X | 1069770 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1069770 | 01 | TX | ADVANCED PRACTICE REGISTERED NURSE LICENSE | OTHER | 2021210051 | 01 | ANCC PMHNP-BC CERTIFICATION | OTHER | 887018 | 01 | TX | REGISTERED NURSE | OTHER |