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NPI Code Detail

MEDICARE: MR. CRAIG DAVID MUELLER FNP

MEDICARE: MR. CRAIG DAVID MUELLER FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner652397TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
182827OTHERARBLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38N7142OTHERTXBLUE SHIELD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164448155
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CRAIG DAVID MUELLER FNP
Provider Business Mailing Address
First Line : 2101 GALLERIA OAKS DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4625
Country : US
Telephone Number : 903-791-9120
Fax Number : 903-791-9132
Provider Business Practice Location Address
First Line : 5212 W 7TH ST
Second Line :
City : WAKE VILLAGE
State : TX
Zip : 75501-5930
Country : US
Telephone Number : 903-831-6848
Fax Number : 903-223-7089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 02/04/2013

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