Basic Information
| Provider Information | |||||||||
| NPI: | 1790784494 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOUCK | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSN, RNCS, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 177 TREETOP TRL | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760153845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173191177 | ||||||||
| FaxNumber: | 8175570699 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 7TH ST | ||||||||
| Address2: | SUITE 121 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761022651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173480425 | ||||||||
| FaxNumber: | 8173480455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 03/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 516571 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 092888910 | 05 | TX | MEDICAID | 092888909 | 05 | TX | MEDICAID |