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General NPI Number Information
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NPI Number | 1972077063
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Entity Type | Organization
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Legal Business Name | SABINE VALLEY MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 4702 WESLEY ST STE B
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City | GREENVILLE
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State | TX
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Zip | 75401-5663
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Country | US
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Telephone | 214-683-7481
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Fax | 214-722-6996
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Provider Business Mailing Address
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Address Line | 4702 WESLEY ST STE B
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City | GREENVILLE
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State | TX
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Zip | 75401-5663
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Country | US
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Telephone | 214-683-7481
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Fax | 214-722-6996
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Authorized Official
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Title or Position | FNP/OWNER
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Name | PENNY JO PICKLE KRISPIN
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Credential | FNP
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Telephone | 903-450-0710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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