JACKIE IJEOMA PENN NP NPI 1972940260

NPI Information

  • NPI: 1972940260
  • Provider Name: JACKIE IJEOMA PENN, NP
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 5319 NUECES LN
    GRAND PRAIRIE, TX
    ZIP 75052
  • Phone: (214) 584-4103

Map and Directions

Get Directions

NPI Details

Jackie Ijeoma Penn, NP is a psychiatric/mental health nurse practitioner in Grand Prairie, TX with 5 years of experience. Jackie Ijeoma Penn, NP NPI is 1972940260. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

5319 NUECES LN
GRAND PRAIRIE, TX
ZIP 75052-667
Phone: (214) 584-4103

The NPI 1972940260 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/28/2013 and was last updated on 5/3/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163W00000XRegistered Nurse783349TEXASNo
2363LP0808XNurse PractitionerPsychiatric/Mental Health1056737TEXASYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI