Provider Demographics
NPI:1528583739
Name:MACIAS, RICHARD PAUL (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:MACIAS
Suffix:
Gender:M
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 VILLA PLATA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-2520
Mailing Address - Country:US
Mailing Address - Phone:915-433-7618
Mailing Address - Fax:
Practice Address - Street 1:1600 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5622
Practice Address - Country:US
Practice Address - Phone:915-533-8398
Practice Address - Fax:915-533-8656
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily