Provider Demographics
NPI:1770554255
Name:BARGFELDT, JANIS LOUISE (RN, GNP-C)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:LOUISE
Last Name:BARGFELDT
Suffix:
Gender:F
Credentials:RN, GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11004 FM 773
Mailing Address - Street 2:
Mailing Address - City:MURCHISON
Mailing Address - State:TX
Mailing Address - Zip Code:75778-1761
Mailing Address - Country:US
Mailing Address - Phone:903-469-3255
Mailing Address - Fax:903-469-3255
Practice Address - Street 1:11004 FM 773
Practice Address - Street 2:
Practice Address - City:MURCHISON
Practice Address - State:TX
Practice Address - Zip Code:75778-1761
Practice Address - Country:US
Practice Address - Phone:903-469-3255
Practice Address - Fax:903-469-3255
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX626597363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612107Medicare ID - Type Unspecified
TXQ58504Medicare UPIN