MEDICARE: MARY RUTH ANDERSON NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	733590	TX
2	363LF0000X	Family Nurse Practitioner	AP120985	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093092926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY RUTH ANDERSON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	3419 22ND ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79410-1334
Country	:	US
Telephone Number	:	806-796-3000
Fax Number	:	806-796-3006

Provider Business Practice Location Address
First Line	:	6826 PLUM CREEK DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79124-1601
Country	:	US
Telephone Number	:	806-322-3000
Fax Number	:	806-322-3006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2011
Last Update Date	:	05/13/2020

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