Provider Demographics
NPI:1578567517
Name:CHAMPION, JANE D (PHD, CS, FNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:D
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:PHD, CS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GARNER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-6210
Mailing Address - Country:US
Mailing Address - Phone:830-278-4453
Mailing Address - Fax:830-278-3427
Practice Address - Street 1:1800 GARNER FIELD RD
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-6210
Practice Address - Country:US
Practice Address - Phone:830-278-4453
Practice Address - Fax:830-278-3427
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239515363LF0000X, 207Q00000X, 2083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017801401Medicaid
TX029245003Medicaid
TX239515OtherSTATE LICENSE
TX063389301Medicaid
TX029245002Medicaid
TX083850001Medicaid
TX453835Medicare ID - Type UnspecifiedMEDICARE RHC
TX00L82SMedicare ID - Type UnspecifiedMEDICARE
TX029245002Medicaid