Basic Information
| Provider Information | |||||||||
| NPI: | 1962461897 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENDSLEY | ||||||||
| FirstName: | EMALIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7008 INDIANA AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794136114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066988088 | ||||||||
| FaxNumber: | 8066988588 | ||||||||
| Practice Location | |||||||||
| Address1: | 7008 INDIANA AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794136114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066988088 | ||||||||
| FaxNumber: | 8066988588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 12/04/2009 | ||||||||
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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 | 363L00000X | 525266 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 172418901 | 05 | TX | MEDICAID |