1194152959 NPI number — MRS. PAULINE WINSOME MCLARTY-NEVERS ACNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194152959 NPI number — MRS. PAULINE WINSOME MCLARTY-NEVERS ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLARTY-NEVERS
Provider First Name:
PAULINE
Provider Middle Name:
WINSOME
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCLARTY-NEVERS
Provider Other First Name:
PAULINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ACNP-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194152959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 LANCASTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051-2109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-576-6665
Provider Business Mailing Address Fax Number:
817-576-6663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7777 FOREST LANE,
Provider Second Line Business Practice Location Address:
BUILDING B, SUITE 200
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-566-8900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2013

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: 363LA2100X , with the licence number:  654559 , 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)





Copyright © 2007-2025 www.npivalidator.com