Healthcare Provider Details

I. General information

NPI: 1245422096
Provider Name (Legal Business Name): ROBERT W. FARRIS JR. APRN,BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 S WELLS ST
EDNA TX
77957-4045
US

IV. Provider business mailing address

204 S. 4TH STREET
GANADO TX
77962
US

V. Phone/Fax

Practice location:
  • Phone: 361-782-7820
  • Fax: 361-782-5627
Mailing address:
  • Phone: 361-771-3311
  • Fax: 361-771-3081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number594549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: