Provider Demographics
NPI:1659490423
Name:O'FARRELL, NANCY LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LOUISE
Last Name:O'FARRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W. LOOP 340
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-776-0418
Mailing Address - Fax:254-741-9638
Practice Address - Street 1:701 W. LOOP 340
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:512-467-7232
Practice Address - Fax:512-467-7203
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00206TX2083X0100X
TXPA00206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine