Healthcare Provider Details

I. General information

NPI: 1346364999
Provider Name (Legal Business Name): PATRICIA BUMGARNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N HOUSTON ST
KAUFMAN TX
75142-1950
US

IV. Provider business mailing address

PO BOX 1908
GREENVILLE TX
75403-1908
US

V. Phone/Fax

Practice location:
  • Phone: 972-932-7001
  • Fax: 972-932-7007
Mailing address:
  • Phone: 903-454-3025
  • Fax: 903-450-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number629355
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: