=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861173098
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIAH GIRARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2023
-----------------------------------------------------
Last Update Date | 06/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3551 ROGER BROOKE DR
-----------------------------------------------------
City | FORT SAM HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78234-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-539-0000
-----------------------------------------------------
Fax | 210-916-6658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2130 NE INTERSTATE 410 LOOP # 325
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-4208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-653-2693
-----------------------------------------------------
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 | 1025340
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------