Provider Demographics
NPI:1043223878
Name:PRICE, DERYLANN C (RN,FNP)
Entity Type:Individual
Prefix:
First Name:DERYLANN
Middle Name:C
Last Name:PRICE
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 RICKEY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5522
Mailing Address - Country:US
Mailing Address - Phone:817-557-1072
Mailing Address - Fax:817-466-2854
Practice Address - Street 1:1017 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2513
Practice Address - Country:US
Practice Address - Phone:817-469-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254037363LF0000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039571701Medicaid
TX039571705Medicaid
TX039571703Medicaid
TX039571704Medicaid
TX81N272OtherBCBS
TXTXB126155Medicare PIN
TX039571705Medicaid
TXTXB126156Medicare PIN