1871721597 NPI number — STEPHANIE PAIGE BRISCOE NORRIS FNP-C

Table of content: STEPHANIE PAIGE BRISCOE NORRIS FNP-C (NPI 1871721597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871721597 NPI number — STEPHANIE PAIGE BRISCOE NORRIS FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORRIS
Provider First Name:
STEPHANIE
Provider Middle Name:
PAIGE BRISCOE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1871721597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 E RENFRO ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BURLESON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76028-3947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-295-3100
Provider Business Mailing Address Fax Number:
817-295-3158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 E RENFRO ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-3947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-295-3100
Provider Business Practice Location Address Fax Number:
817-295-3158
Provider Enumeration Date:
07/01/2009

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: 363LF0000X , with the licence number:  695907 , 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: 282401303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 282401302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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