Provider Demographics
NPI:1942460985
Name:MAGNESS, VANESSA KAY (RT(R))
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:KAY
Last Name:MAGNESS
Suffix:
Gender:F
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3872 STATE HIGHWAY 64 W # 243
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-6924
Mailing Address - Country:US
Mailing Address - Phone:903-363-9583
Mailing Address - Fax:903-363-9583
Practice Address - Street 1:774 AIRWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704-7806
Practice Address - Country:US
Practice Address - Phone:903-363-9583
Practice Address - Fax:903-363-9583
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197352471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45X0009914Medicare Oscar/Certification