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General NPI Number Information
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NPI Number | 1841820099
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Entity Type | Individual
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Provider Name | JUSTIN D DOUGLAS MSN, FNP, CNS, APRN
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Gender | Male
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 1400 GEORGE DIETER DR
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City | EL PASO
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State | TX
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Zip | 79936-7653
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Country | US
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Telephone | 336-244-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 GEORGE DIETER DR
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City | EL PASO
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State | TX
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Zip | 79936-7653
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Country | US
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Telephone | 336-244-0444
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 68193
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 68193
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95191512
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 68193
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 364SC0200X
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Taxonomy Name | Critical Care Medicine Clinical Nurse Specialist
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License Number | 1180827
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License Number State | TX
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