Basic Information
| Provider Information | |||||||||
| NPI: | 1043766272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANGEL | ||||||||
| FirstName: | BLANCA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5012 US HWY 75 S, SUITE 300 | ||||||||
| Address2: | ATT BILLING | ||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063517510 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1411 E AMARILLO BLVD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791075555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063517510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SF0001X | AP130807 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | 363L00000X | AP130807 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3624249-01 | 05 | TX | MEDICAID |