Healthcare Provider Details

I. General information

NPI: 1659514941
Provider Name (Legal Business Name): STEPHANIE ANDREA FOXX IDMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 LOUISIANA RD
DYESS AFB TX
79607-1141
US

IV. Provider business mailing address

5188 WESTERN PLAINS AVE
ABILENE TX
79606-5368
US

V. Phone/Fax

Practice location:
  • Phone: 325-699-8478
  • Fax:
Mailing address:
  • Phone: 325-701-4753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: