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NPI Code Detail

MEDICARE: DAVID STATEN APRN; A/G ACNP

MEDICARE: DAVID STATEN APRN; A/G ACNP
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
1163W00000XRegistered Nurse663393TX
2363LC0200XCritical Care Medicine Nurse PractitionerAP125278TX
3363LF0000XFamily Nurse PractitionerAP125278TX
4363LA2100XAcute Care Nurse PractitionerAP125278TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01402891OTHERTXRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
28889NJOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1831515667
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID STATEN APRN; A/G ACNP
Provider Business Mailing Address
First Line : 6516 NEW RD
Second Line :
City : NORTH ZULCH
State : TX
Zip : 77872-6337
Country : US
Telephone Number : 281-740-2405
Fax Number :
Provider Business Practice Location Address
First Line : 700 SCOTT AND WHITE DR
Second Line :
City : COLLEGE STATION
State : TX
Zip : 77845-6441
Country : US
Telephone Number : 979-207-0100
Fax Number : 979-207-2161
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2014
Last Update Date : 03/29/2024

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