Healthcare Provider Details

I. General information

NPI: 1255922936
Provider Name (Legal Business Name): RICHARD W. ORNBERG DNP, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 WORTH ST
DALLAS TX
75246-1607
US

IV. Provider business mailing address

6148 PROSPECT AVE
DALLAS TX
75214-3932
US

V. Phone/Fax

Practice location:
  • Phone: 214-623-6830
  • Fax: 214-623-6807
Mailing address:
  • Phone: 214-519-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1028563
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: