Provider Demographics
NPI:1972830909
Name:RUSSELL, DENISE BLACKARD (RN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:BLACKARD
Last Name:RUSSELL
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Gender:F
Credentials:RN, FNP-C
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Mailing Address - Street 1:399 W CAMPBELL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3595
Mailing Address - Country:US
Mailing Address - Phone:972-238-1848
Mailing Address - Fax:972-238-8735
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3595
Practice Address - Country:US
Practice Address - Phone:972-238-1848
Practice Address - Fax:972-238-8735
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
TXAP114207363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMR4549602OtherDEA