MEDICARE: THERESA LYNN HADDOX 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	251E00000X	Home Health Agency
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	AP142913	TX

General Provider Information

NPI Number	:	1477033868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA LYNN HADDOX NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	333 LONDONDERRY DR STE 200
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-7930
Country	:	US
Telephone Number	:	254-751-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 LONDONDERRY DR STE 200
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-7930
Country	:	US
Telephone Number	:	254-751-9777
Fax Number	:	254-751-9788

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

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	05/29/2020

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