NPI age
19 years
Enumerated 2006-07-20
Across 982 active nurse practitioner providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 139696218 | |
| 01 (TX) | 244159 | STATE LICENSE |
| 01 (TX) | 10007060 | AMERIGROUP ID # |
| 01 (TX) | 89N734 | BLUE CROSS &BLUE SHIELD |
Part of a multi-provider practice. 15 other active providers share this practice address in NPPES.
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