1962789537 NPI number — JANA PICTON RN, FNP

Table of content: (NPI 1962789537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962789537 NPI number — JANA PICTON RN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANA PICTON RN, FNP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962789537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11797 SOUTH FWY STE 338
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLESON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76028-7035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-568-3274
Provider Business Mailing Address Fax Number:
817-568-5434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11797 SOUTH FWY STE 338
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-7035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-568-3274
Provider Business Practice Location Address Fax Number:
817-568-5434
Provider Enumeration Date:
11/10/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PICTON
Authorized Official First Name:
JANA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
817-568-3274

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  F7785 , 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)

  • Identifier: F7785 . This is a "BOARD OF NURSE EXAMINERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".