Provider Demographics
NPI:1497709380
Name:VERNOR, GLENDA KAY (FNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:KAY
Last Name:VERNOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ZEID BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-6069
Mailing Address - Country:US
Mailing Address - Phone:903-655-1153
Mailing Address - Fax:903-655-0620
Practice Address - Street 1:100 ZEID BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-6069
Practice Address - Country:US
Practice Address - Phone:903-655-1153
Practice Address - Fax:903-655-0620
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178236901Medicaid
TXQ31700Medicare UPIN
TX8C9923Medicare PIN