Provider Demographics
NPI:1659817120
Name:EASTER, PRENTICE
Entity type:Individual
Prefix:MS
First Name:PRENTICE
Middle Name:
Last Name:EASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 SPRUCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1319
Mailing Address - Country:US
Mailing Address - Phone:469-230-6838
Mailing Address - Fax:
Practice Address - Street 1:949 SPRUCEWOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1319
Practice Address - Country:US
Practice Address - Phone:469-230-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator