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General NPI Number Information
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NPI Number | 1245877000
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Entity Type | Individual
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Provider Name | STEPHEN RAY HALBERG
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Gender | Male
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Dates
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Enumeration Date | 11/28/2019
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Last Update Date | 12/07/2019
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Provider Practice Location Address
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Address Line | 901 INDIANA AVE STE 540
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City | WICHITA FALLS
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State | TX
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Zip | 76301-6734
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Country | US
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Telephone | 940-249-5253
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 KINTA TRL
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City | WICHITA FALLS
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State | TX
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Zip | 76310-8165
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Country | US
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Telephone | 940-782-6626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP144219
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License Number State | TX
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