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General NPI Number Information
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NPI Number | 1598274128
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Entity Type | Individual
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Provider Name | SUZZAN BEA FLEMING
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Gender | Female
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 1620 FM 3344
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City | JACKSBORO
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State | TX
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Zip | 76458
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Country | US
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Telephone | 940-567-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 408 HASTINGS DR
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City | RUNAWAY BAY
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State | TX
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Zip | 76426-9709
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Country | US
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Telephone | 817-456-4513
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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 | 577440
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License Number State | TX
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