Basic Information
| Provider Information | |||||||||
| NPI: | 1689214637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARRAR | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | WADE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 CREEKWOOD RANCH RD | ||||||||
| Address2: | |||||||||
| City: | AZLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760208045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172394104 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 E BYPASS 287 | ||||||||
| Address2: | |||||||||
| City: | ALVORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762257778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404272858 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2020 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP144494 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.