Healthcare Provider Details

I. General information

NPI: 1437265071
Provider Name (Legal Business Name): SUSAN R GLADDEN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 DENVER ST
WICHITA FALLS TX
76301-2110
US

IV. Provider business mailing address

1325 PENNSYLVANIA AVE SUITE 890
FORT WORTH TX
76104-2158
US

V. Phone/Fax

Practice location:
  • Phone: 940-720-3500
  • Fax: 940-397-3150
Mailing address:
  • Phone: 817-878-5333
  • Fax: 817-878-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number640526
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAP132268
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: