Basic Information
| Provider Information | |||||||||
| NPI: | 1528302130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEGARD | ||||||||
| FirstName: | JEFFRY | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | R.N., DNP-FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | BROOKER ARMY MEDICAL CTR | ||||||||
| Address2: | 3551 ROGER BROOKE DRIVE, | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105399582 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BROOKE ARMY MEDICAL CENTER | ||||||||
| Address2: | 3551 ROGER BROOKE DR | ||||||||
| City: | JBSA FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105399582 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2012 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP141700 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | AP60676999 | 01 | WA | APRN - NP LICENSE | OTHER | 966505 | 01 | TX | RN LICENSE | OTHER | RN60610220 | 01 | WA | RN LICENSE | OTHER | 705686 | 01 | CA | RN LICENSE | OTHER |