Provider Demographics
NPI:1790762060
Name:NUNNELEY, ANTOINETTE RENE (ANP)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:RENE
Last Name:NUNNELEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:RENE
Other - Last Name:SCHRIEWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:4001 CEDAR ELM LN STE B
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3031
Mailing Address - Country:US
Mailing Address - Phone:940-386-9334
Mailing Address - Fax:940-386-9733
Practice Address - Street 1:4001 CEDAR ELM LN STE B
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3031
Practice Address - Country:US
Practice Address - Phone:940-386-9334
Practice Address - Fax:940-386-9733
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541470363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144490304Medicaid
TX144490302Medicaid
TX144490304Medicaid
TX8A2497Medicare ID - Type Unspecified607K
TX144490302Medicaid
TX88451HMedicare ID - Type Unspecified606K