Provider Demographics
NPI:1285197616
Name:SUMMERS, IRENE K (FNP-C)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:K
Last Name:SUMMERS
Suffix:
Gender:F
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 1:3610 W PIONEER PKWY STE 124
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4502
Mailing Address - Country:US
Mailing Address - Phone:817-226-0501
Mailing Address - Fax:
Practice Address - Street 1:1788 HIGHWAY 157 N STE 124
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3989
Practice Address - Country:US
Practice Address - Phone:817-226-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF03190922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily