Healthcare Provider Details

I. General information

NPI: 1073913422
Provider Name (Legal Business Name): CHRISTENE FARMER LSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W RANDOL MILL RD
ARLINGTON TX
76012-2504
US

IV. Provider business mailing address

PO BOX 2550
ROWLETT TX
75030-2550
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00679
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: