1316001829 NPI number — MRS. PAULA JOANN STROUD RNC WHCNP

Table of content: MRS. PAULA JOANN STROUD RNC WHCNP (NPI 1316001829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316001829 NPI number — MRS. PAULA JOANN STROUD RNC WHCNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROUD
Provider First Name:
PAULA
Provider Middle Name:
JOANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RNC WHCNP
Provider Gender Code:
F

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:
1316001829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4655 FM 314
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEN WHEELER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75754-4009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-676-5480
Provider Business Mailing Address Fax Number:
903-676-5489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1334 S PALESTINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75751-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-676-5480
Provider Business Practice Location Address Fax Number:
903-616-5489
Provider Enumeration Date:
12/20/2006

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: 363LW0102X , with the licence number:  629756 , 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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