Healthcare Provider Details

I. General information

NPI: 1255431649
Provider Name (Legal Business Name): JUDY L FARNESS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 MEDICAL CENTER DR STE 400 4TH FLOOR
EL PASO TX
79902-5000
US

IV. Provider business mailing address

1626 MEDICAL CENTER DR STE 400 4TH FLOOR
EL PASO TX
79902-5000
US

V. Phone/Fax

Practice location:
  • Phone: 915-546-9200
  • Fax: 915-546-9800
Mailing address:
  • Phone: 915-546-9200
  • Fax: 915-546-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number428622
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: