Provider Demographics
NPI:1619004942
Name:REVOIR, EDITH LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:LYNN
Last Name:REVOIR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 MICHAEL CT
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1037
Mailing Address - Country:US
Mailing Address - Phone:325-692-5728
Mailing Address - Fax:
Practice Address - Street 1:6200 REGIONAL PLZ
Practice Address - Street 2:SUITE 1200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5250
Practice Address - Country:US
Practice Address - Phone:325-690-1805
Practice Address - Fax:325-690-6145
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX517956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily