=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790106649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANET S. WHEAT, RN, MS, FNP-C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2013
-----------------------------------------------------
Last Update Date | 09/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 813 W WHITE ST SUITE 100
-----------------------------------------------------
City | ANNA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75409-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-924-8224
-----------------------------------------------------
Fax | 972-924-8226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 813 W WHITE ST SUITE 100
-----------------------------------------------------
City | ANNA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75409-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-924-8224
-----------------------------------------------------
Fax | 972-924-8226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JANET S WHEAT
-----------------------------------------------------
Credential | DNP, APEN, FNP-C
-----------------------------------------------------
Telephone | 972-924-8224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 602339
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------