Basic Information
| Provider Information | |||||||||
| NPI: | 1871164798 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEIFERT | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | APRN NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3809 E 9TH ST STE 15 | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718545818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032776877 | ||||||||
| FaxNumber: | 8706210081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 PINE ST | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755015100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037988000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2021 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WF0300X | 907299 | TX | N | Nursing Service Providers | Registered Nurse | Flight | 363LF0000X | 216888 | AR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 1046231 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.