Provider Demographics
NPI:1346897766
Name:FANNING, WILL ROYDEN III
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:ROYDEN
Last Name:FANNING
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 FISHING HOLE LN
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4853
Mailing Address - Country:US
Mailing Address - Phone:817-779-1778
Mailing Address - Fax:
Practice Address - Street 1:13600 FISHING HOLE LN
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-4853
Practice Address - Country:US
Practice Address - Phone:817-779-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider