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General NPI Number Information
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NPI Number | 1396639886
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Entity Type | Individual
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Provider Name | JUSTIN LEE WREN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 06/07/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 805 HILL BLVD UNIT 102
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City | GRANBURY
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State | TX
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Zip | 76048-1482
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Country | US
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Telephone | 682-205-3690
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14950
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City | OKLAHOMA CITY
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State | OK
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Zip | 73113-0950
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Country | US
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Telephone | 682-205-3690
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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 | 1000392
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License Number State | TX
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