Provider Demographics
NPI:1457791824
Name:ST CLAIR, KANSAS MARIE (FNP)
Entity type:Individual
Prefix:
First Name:KANSAS
Middle Name:MARIE
Last Name:ST CLAIR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1334
Mailing Address - Country:US
Mailing Address - Phone:806-796-3000
Mailing Address - Fax:806-796-3006
Practice Address - Street 1:3419 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1334
Practice Address - Country:US
Practice Address - Phone:806-796-3000
Practice Address - Fax:806-796-3006
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123878363LF0000X
TX702520364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1T9764OtherMEDICARE
TX331227403Medicaid
TX8QC171OtherBCBS
NM1457791824OtherBCBS
NM66058546Medicaid