=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184694358
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BELINDA MARIE FORD FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3851 ROGER BROOKE DR
-----------------------------------------------------
City | FORT SAM HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78234-4501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-222-0030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1219 ALEXWOOD DR
-----------------------------------------------------
City | HOPE MILLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28348-5603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-425-1577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 154959
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------