Basic Information
| Provider Information | |||||||||
| NPI: | 1942332598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTIAN FAMILY HOUSE CALLS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2810 CROMWELL AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763094024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402249274 | ||||||||
| FaxNumber: | 9405694969 | ||||||||
| Practice Location | |||||||||
| Address1: | 2810 CROMWELL AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763094024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402249274 | ||||||||
| FaxNumber: | 9405694969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 08/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | HANSEN | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9402249274 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CFNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 570268 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.