Provider Demographics
NPI:1265471445
Name:RUSSELL, JAMES JR (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:RUSSELL
Suffix:JR
Gender:M
Credentials:FNP-C
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 201
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-0201
Mailing Address - Country:US
Mailing Address - Phone:806-355-8900
Mailing Address - Fax:806-355-2453
Practice Address - Street 1:400 SW 14TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-4140
Practice Address - Country:US
Practice Address - Phone:806-337-4555
Practice Address - Fax:806-337-4551
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564-160363LF0000X
TXAP110091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153899302Medicaid
TX153899302Medicaid
8L5960Medicare PIN