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General NPI Number Information
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NPI Number | 1932921293
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Entity Type | Organization
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Legal Business Name | VILLAGE PEDIATRICS WACO PLLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 4515 LAKE SHORE DR
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City | WACO
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State | TX
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Zip | 76710-1814
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Country | US
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Telephone | 254-269-3099
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Fax |
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Provider Business Mailing Address
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Address Line | 1046 MORNING STAR CIR
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City | CHINA SPRING
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State | TX
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Zip | 76633-3316
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Country | US
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Telephone | 254-744-4777
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | CATHERINE P PRICE
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Credential | DNP
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Telephone | 254-744-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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