Provider Demographics
NPI:1154439362
Name:VA NORTH TEXAS HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:VA NORTH TEXAS HEALTH CARE SYSTEM
Other - Org Name:DALLAS VA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRUSS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:214-742-8387
Mailing Address - Street 1:7107 CLAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-9425
Mailing Address - Country:US
Mailing Address - Phone:214-348-0866
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-742-8387
Practice Address - Fax:214-462-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX457755282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital