NPI age
19 years
Enumerated 2006-11-02
Across 22123 active nurse practitioner providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | DC6861 | LICENCE NUMBER |
| 01 (TX) | 742920952 | TAX IDENTIFICATION |
| 05 (TX) | 002110701 | |
| 01 (TX) | 8A1120 | BCBS PROVIDER |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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