Provider Demographics
NPI:1073989885
Name:WARD, SUSAN (AGAC-NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 VOLLEY LN
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-6034
Mailing Address - Country:US
Mailing Address - Phone:214-500-7167
Mailing Address - Fax:
Practice Address - Street 1:3202 S W S YOUNG DR
Practice Address - Street 2:SUITE #102
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6537
Practice Address - Country:US
Practice Address - Phone:254-247-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-16
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128126363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology