Basic Information
Provider Information
NPI: 1003139833
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WARD
FirstName: VALERIE
MiddleName: ELISE
NamePrefix:  
NameSuffix:  
Credential: RN, CPNP-PC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2755 MILLER AVE
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761054164
CountryCode: US
TelephoneNumber: 8175347110
FaxNumber: 8174130521
Practice Location
Address1: 2805 E GRAPEVINE MILLS CIR
Address2: STE 120
City: GRAPEVINE
State: TX
PostalCode: 76051
CountryCode: US
TelephoneNumber: 9726910200
FaxNumber: 9726910201
Other Information
ProviderEnumerationDate: 03/08/2010
LastUpdateDate: 05/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200X702772TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
363LP2300X702772TXN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care

ID Information
IDTypeStateIssuerDescription
21380260905TX MEDICAID
21380260105TX MEDICAID
21380260205TX MEDICAID
21380260505TX MEDICAID


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