Provider Demographics
NPI:1689214637
Name:FARRAR, JUSTIN WADE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WADE
Last Name:FARRAR
Suffix:
Gender:M
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 1:139 CREEKWOOD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-8045
Mailing Address - Country:US
Mailing Address - Phone:817-239-4104
Mailing Address - Fax:
Practice Address - Street 1:115 E BYPASS 287
Practice Address - Street 2:
Practice Address - City:ALVORD
Practice Address - State:TX
Practice Address - Zip Code:76225-7778
Practice Address - Country:US
Practice Address - Phone:940-427-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily