Healthcare Provider Details

I. General information

NPI: 1346731981
Provider Name (Legal Business Name): VANESSA BOUNDS AGACNP, RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 01/31/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 INDIANA AVE STE 540
WICHITA FALLS TX
76301-6734
US

IV. Provider business mailing address

2609 CHASE DR
WICHITA FALLS TX
76308-5307
US

V. Phone/Fax

Practice location:
  • Phone: 940-249-5253
  • Fax:
Mailing address:
  • Phone: 913-593-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number838643
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP136993
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: