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General NPI Number Information
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NPI Number | 1972830909
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Entity Type | Individual
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Provider Name | DENISE BLACKARD RUSSELL RN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 399 W CAMPBELL RD SUITE 101
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City | RICHARDSON
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State | TX
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Zip | 75080-3595
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Country | US
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Telephone | 972-238-1848
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Fax | 972-238-8735
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Provider Business Mailing Address
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Address Line | 399 W CAMPBELL RD SUITE 101
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City | RICHARDSON
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State | TX
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Zip | 75080-3595
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Country | US
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Telephone | 972-238-1848
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Fax | 972-238-8735
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP114207
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License Number State | TX
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