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General NPI Number Information
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NPI Number | 1881102333
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Entity Type | Individual
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Provider Name | TIMOTHY LOUIS SAHAGUN
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Gender | Male
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 121 CAHILL RD STE 204
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City | BRANSON
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State | MO
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Zip | 65616-1911
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Country | US
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Telephone | 417-619-3139
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Fax |
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Provider Business Mailing Address
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Address Line | 261 QUAIL CREEK RD
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City | ROCKWALL
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State | TX
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Zip | 75032-7163
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Country | US
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Telephone | 972-832-3659
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP135400
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2018000922
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License Number State | MO
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