=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841756491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY SUSAN SKRABANEK FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2019
-----------------------------------------------------
Last Update Date | 05/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 LOCKWOOD ST
-----------------------------------------------------
City | TAHOKA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79373-4118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-998-4533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5417 89TH ST
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79424-3523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-766-7298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP139136
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------