=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689130569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C.M. SPEAKS, N.P., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2019
-----------------------------------------------------
Last Update Date | 02/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 S HENDERSON BLVD
-----------------------------------------------------
City | KILGORE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75662-4033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-738-5890
-----------------------------------------------------
Fax | 866-842-1649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1202 JASMINE LN
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75604-2836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-738-5890
-----------------------------------------------------
Fax | 866-842-1649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | MRS. CYNTHIA SPEAKS
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 903-738-5890
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------