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General NPI Number Information
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NPI Number | 1376954743
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Entity Type | Organization
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Legal Business Name | ABILENE FAMILY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 4542 S 14TH ST
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City | ABILENE
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State | TX
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Zip | 79605-4737
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Country | US
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Telephone | 325-701-9961
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Fax |
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Provider Business Mailing Address
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Address Line | 4542 S 14TH ST
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City | ABILENE
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State | TX
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Zip | 79605-4737
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FREDDIE R JOHNSON
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Credential | FNP
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Telephone | 325-701-9961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 603150
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License Number State | TX
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