1477084531 NPI number — MRS. MARTHA MARIE NELMS MS/CCC-SLP

Table of content: MRS. MARTHA MARIE NELMS MS/CCC-SLP (NPI 1477084531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477084531 NPI number — MRS. MARTHA MARIE NELMS MS/CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELMS
Provider First Name:
MARTHA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS/CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NORWOOD
Provider Other First Name:
MARTHA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS/CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477084531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 N MACARTHUR BLVD STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-579-8155
Provider Business Mailing Address Fax Number:
972-579-4398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4901 BRYANT IRVIN RD N
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76107-7673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-738-9866
Provider Business Practice Location Address Fax Number:
817-738-3157
Provider Enumeration Date:
03/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  106520 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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