Provider Demographics
NPI:1649799214
Name:NOBLE, CHARITY A (FNP)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:A
Last Name:NOBLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:A
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2101 GALLERIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4625
Mailing Address - Country:US
Mailing Address - Phone:903-691-9769
Mailing Address - Fax:
Practice Address - Street 1:4105 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4861
Practice Address - Country:US
Practice Address - Phone:903-838-0444
Practice Address - Fax:903-334-7618
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX746172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX746172OtherTEXAS BON