Provider Demographics
NPI:1689319113
Name:OGLESBY, MARTHA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 BLUEBIRD LANE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-6236
Mailing Address - Country:US
Mailing Address - Phone:972-617-6660
Mailing Address - Fax:
Practice Address - Street 1:206 WOODED MEADOW LN
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-6236
Practice Address - Country:US
Practice Address - Phone:972-617-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily