Provider Demographics
NPI:1275248494
Name:FORD, SERENITY (CNC, CPT)
Entity Type:Individual
Prefix:
First Name:SERENITY
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:CNC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-3825
Mailing Address - Country:US
Mailing Address - Phone:806-661-8951
Mailing Address - Fax:
Practice Address - Street 1:601 W KENTUCKY AVE STE 209
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-4221
Practice Address - Country:US
Practice Address - Phone:806-661-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No171400000XOther Service ProvidersHealth & Wellness Coach