Provider Demographics
NPI:1093759862
Name:LEDFORD, WILLIAM A (FNP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:A
Other - Last Name:LEDFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7306 SW 34TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1446
Mailing Address - Country:US
Mailing Address - Phone:806-350-8850
Mailing Address - Fax:806-350-8855
Practice Address - Street 1:7306 SW 34TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1446
Practice Address - Country:US
Practice Address - Phone:806-350-8850
Practice Address - Fax:806-350-8855
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX576559363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088278909Medicaid
TX088278909Medicaid