Provider Demographics
NPI:1154821155
Name:RUSSELL, ROY ANTHONY (RN)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:ANTHONY
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9127 COUNTY ROAD 2035
Mailing Address - Street 2:
Mailing Address - City:SINTON
Mailing Address - State:TX
Mailing Address - Zip Code:78387-5009
Mailing Address - Country:US
Mailing Address - Phone:361-222-2077
Mailing Address - Fax:
Practice Address - Street 1:9127 COUNTY ROAD 2035
Practice Address - Street 2:
Practice Address - City:SINTON
Practice Address - State:TX
Practice Address - Zip Code:78387-5009
Practice Address - Country:US
Practice Address - Phone:361-222-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX851633163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse