Jacob Scivally

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

200639 Issued in TX

Practice address

301 N Washington Ave
Dallas, TX 75246-1754

Phone

(254) 202-1272

Fax

(469) 800-8335

NPI assigned

Dec 5, 2023

Last updated

Dec 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1316714926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 ANDREWS PKWY APT 2124",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750022961",
            "telephone_number": "469-268-0635",
            "fax_number": "469-800-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N WASHINGTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461754",
            "telephone_number": "254-202-1272",
            "fax_number": "469-800-8335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCIVALLY",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-05",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "TX",
            "license": "200639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clair Alan Schwendeman, MD
• Matthew Robert Schwenke, MD
• Christine Monique Schwiebert, PA-C
• Shanon G Schwimmer, M.D.
• Francesca Scilla Smith, D.D.S., M.S.
• Hailee Scoggins
• Heather Scoggins, PHARMD
• Marion Elizabeth Scoggins, MD
• Romy Scoggins, RD
• Natasha Stephanie Scogin

• Pharmacy Technician in Dallas, TX
• Providers in Dallas, TX by specialty
• Pharmacy Technician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.