Provider Demographics
NPI:1275533663
Name:VIDAL-KUTIN, MARGARET (WHCNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:VIDAL-KUTIN
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S FANNIN AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8204
Mailing Address - Country:US
Mailing Address - Phone:903-535-9041
Mailing Address - Fax:
Practice Address - Street 1:928 N GLENWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5055
Practice Address - Country:US
Practice Address - Phone:903-535-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX597340363LW0102X
TXAP107251363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042516705Medicaid
TX042516708Medicaid
TX042516710Medicaid
TX042516704Medicaid
TX042516711Medicaid
TX45-2578435-002OtherTRICARE
TX042516702Medicaid
TX042516707Medicaid
TX042516713Medicaid
TX042516706Medicaid
TX042516709Medicaid
TX042516715Medicaid
TX8971NKOtherBCBS
TX0021YBOtherBCBS
TX042516703Medicaid
TX042516712Medicaid
TX45-2578435-001OtherTICARE
TX452578435001OtherTRICARE
TX857919OtherMEDICARE
TX042516714Medicaid
TX8LV009OtherBCBS
TX8N4773OtherBLUE CROSS BLUE SHIELD
TX042516704Medicaid