Provider Demographics
NPI:1235191446
Name:ALFORD, WILMA DIANE (APRN)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:DIANE
Last Name:ALFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8691
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8691
Mailing Address - Country:US
Mailing Address - Phone:361-579-0315
Mailing Address - Fax:361-579-0325
Practice Address - Street 1:3350 EXECUTIVE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6878
Practice Address - Country:US
Practice Address - Phone:325-245-4501
Practice Address - Fax:325-245-4802
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239659363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092938203Medicaid
TX8B8714Medicare PIN
TXP11169Medicare UPIN
TX092938203Medicaid