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

Jeremy Scott Hataway, FNP-BC

Individual provider Family Nurse Practitioner · NPI 1528203155

Jeremy Scott Hataway, FNP-BC is a Family Nurse Practitioner in Grand Prairie, Texas. Practices as a sole proprietor. Licensed in North Carolina and Texas.

Licensed in
NC, TX
In the registry since
2008
Specialties on file
2
What do these letters mean?
FNP-BC — Family Nurse Practitioner, Board Certified
A family nurse practitioner certified by the ANCC.

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Practice location Address checks out

4560 Lake Ridge Pkwy Ste 110
Grand Prairie, TX 75052-1707
Phone: (972) 522-7778
Fax: (972) 522-7779
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 670631 (TX)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 5004212 (NC)

Record details

NPI number1528203155
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-BC
Sole proprietorYes
NPI enumeratedDecember 11, 2008
Last updated in NPPESOctober 6, 2021
Certification dateOctober 6, 2021

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