Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jackie Ijeoma Penn, NP

Individual provider Registered Nurse · NPI 1972940260

Jackie Ijeoma Penn, NP is a Nurse Practitioner in Grand Prairie, Texas. Qualified in 2021, 5 years ago. Practices with Rosebud Indian Health Service, a 78-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
5
Licensed in
TX
In the registry since
2013
Specialties on file
2
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

5319 Nueces Ln
Grand Prairie, TX 75052-2667
Phone: (214) 584-4103
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 1056737 (TX)
Registered Nurse Taxonomy 163W00000X · Licence 783349 (TX)

Record details

NPI number1972940260
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorYes
NPI enumeratedMay 28, 2013
Last updated in NPPESMay 3, 2024
Certification dateAugust 30, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Rosebud Indian Health Service — 78 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Grand Prairie