Basic Information
| Provider Information | |||||||||
| NPI: | 1528243524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAVAHL | ||||||||
| FirstName: | FREDA | ||||||||
| MiddleName: | CECELIA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848268 | ||||||||
| Address2: | ATT IPM CREDENTIALING | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034161726 | ||||||||
| FaxNumber: | 9034161701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SE 34TH AVE | ||||||||
| Address2: | UNIT 1800 | ||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791187771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063517540 | ||||||||
| FaxNumber: | 8063517546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2008 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SW0102X | APRN-365 | HI | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Women's Health | 363LW0102X | 449655 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363L00000X | AP104182 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0707739-03 | 05 | TX | MEDICAID |