Provider Demographics
NPI:1437265071
Name:GLADDEN, SUSAN R (RNFA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:GLADDEN
Suffix:
Gender:F
Credentials:RNFA
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Mailing Address - Street 1:1325 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 890
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2158
Mailing Address - Country:US
Mailing Address - Phone:817-878-5333
Mailing Address - Fax:817-878-5334
Practice Address - Street 1:516 DENVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2110
Practice Address - Country:US
Practice Address - Phone:940-720-3500
Practice Address - Fax:940-397-3150
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX640526163WM0705X
TXAP132268364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7700478OtherAETNA
TX8496608OtherCIGNA
TX89N923OtherBCBS OF TEXAS