Healthcare Provider Details

I. General information

NPI: 1689004814
Provider Name (Legal Business Name): HALANA RIDEAU MSN, RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 10/25/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 DALLAS PKWY
PLANO TX
75093-4300
US

IV. Provider business mailing address

1400 KITTERY DR
PLANO TX
75093-5206
US

V. Phone/Fax

Practice location:
  • Phone: 214-394-8847
  • Fax:
Mailing address:
  • Phone: 214-394-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number733229
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012518
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003982
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP124596
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP124596
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: