Jackie Ijeoma Penn, NP in Grand Prairie, TX - Medicare Nurse Practitioner

Jackie Ijeoma Penn, NP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Grand Prairie, Texas. Her current practice location is 5319 Nueces Ln, Grand Prairie, Texas. You can reach out to her office (for appointments etc.) via phone at (214) 584-4103.

Jackie Ijeoma Penn is licensed to practice in Texas (license number 1056737) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1972940260.

Contact Information

	Jackie Ijeoma Penn, NP
	5319 Nueces Ln, Grand Prairie, TX 75052-2667
	(214) 584-4103
	Not Available

Map and Direction

Provider's Profile

Full Name	Jackie Ijeoma Penn
Gender	Female
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	5319 Nueces Ln, Grand Prairie, Texas
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1972940260
Provider Enumeration Date: 05/28/2013
Last Update Date: 05/03/2024

Medicare PECOS Information:

PECOS PAC ID: 2163807173
Enrollment ID: I20220912002193

Medical Identifiers

Medical identifiers for Jackie Ijeoma Penn such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1972940260	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163W00000X	Registered Nurse	783349 (Texas)	Secondary
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	1056737 (Texas)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jackie Ijeoma Penn allows following entities to bill medicare on her behalf.

Entity Name	Rosebud Indian Health Service
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1194757369 PECOS PAC ID: 6901704055 Enrollment ID: O20031226000337

Entity Name	Pine Ridge Indian Health Service Hospital
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1003963497 PECOS PAC ID: 7214825371 Enrollment ID: O20040309001203

Entity Name	Us Televero Health Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1992318992 PECOS PAC ID: 7911318241 Enrollment ID: O20201118000091

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jackie Ijeoma Penn is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Jackie Ijeoma Penn, NP 5319 Nueces Ln, Grand Prairie, TX 75052-2667 Ph: (214) 584-4103	Jackie Ijeoma Penn, NP 5319 Nueces Ln, Grand Prairie, TX 75052-2667 Ph: (214) 584-4103

Reviews and Comments

Nurse Practitioner Nurses in Grand Prairie, TX

Amber Mullins, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 4203 S Carrier Pkwy, Grand Prairie, TX 75052 Phone: 972-642-3190
Mrs. Elsie Manuel, MSN, APRN, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2740 N Hwy 360, Grand Prairie, TX 75050 Phone: 972-606-8300 Fax: 972-606-8597
Joy Ogbimi, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2922 Pegasus Ct, Grand Prairie, TX 75052 Phone: 214-809-0542
Macia Uche Micheal, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 2835 Mariposa Dr, Grand Prairie, TX 75054 Phone: 972-400-3900 Fax: 469-224-9190
Akhere Isenalumhe, PMHNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3012 Fairview Dr, Grand Prairie, TX 75052 Phone: 972-533-5136
Mrs. Susan Renee Carlson, MSN, ANP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2740 N Hwy 360, Suite 100, Grand Prairie, TX 75050 Phone: 972-606-8300 Fax: 972-606-4940
Michael Owusu Agyemang, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2520 W I 20, Grand Prairie, TX 75052 Phone: 972-264-5858 Fax: 972-264-8800

Jackie Ijeoma Penn, NP - Medicare Nurse Practitioner in Grand Prairie, TX