Provider Demographics
NPI:1821876921
Name:MARTIN, CONNOR (CNP)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 MARION RD
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-3288
Mailing Address - Country:US
Mailing Address - Phone:940-536-8165
Mailing Address - Fax:
Practice Address - Street 1:5151 HWY 121
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2601
Practice Address - Country:US
Practice Address - Phone:214-488-5437
Practice Address - Fax:214-488-5438
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136682363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty