Healthcare Provider Details

I. General information

NPI: 1811394752
Provider Name (Legal Business Name): MASON KIZZIAR APRN-FNP, RNFA, CST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 08/29/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S COULTER ST STE B
AMARILLO TX
79106-0703
US

IV. Provider business mailing address

1600 S COULTER ST STE B
AMARILLO TX
79106-0703
US

V. Phone/Fax

Practice location:
  • Phone: 806-602-2361
  • Fax: 806-356-0081
Mailing address:
  • Phone: 806-602-2361
  • Fax: 806-356-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number116194
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number850536
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1070127
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: