Healthcare Provider Details

I. General information

NPI: 1821876921
Provider Name (Legal Business Name): CONNOR MARTIN CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 HWY 121
THE COLONY TX
75056-2601
US

IV. Provider business mailing address

11721 MARION RD
SANGER TX
76266-3288
US

V. Phone/Fax

Practice location:
  • Phone: 214-488-5437
  • Fax: 214-488-5438
Mailing address:
  • Phone: 940-536-8165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1136682
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: