MEDICARE: MR. ROBERT GORDON HANKS JR. FNP

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	602880	TX

General Provider Information

NPI Number	:	1477732485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT GORDON HANKS JR. FNP

Provider Business Mailing Address
First Line	:	UTA SCHOOL OF NURSING
Second Line	:	BOX 19407
City	:	ARLINGTON
State	:	TX
Zip	:	76019-0409
Country	:	US
Telephone Number	:	817-272-2776
Fax Number	:	817-272-5006

Provider Business Practice Location Address
First Line	:	4373 S HAMPTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-1058
Country	:	US
Telephone Number	:	214-986-5239
Fax Number	:

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

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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