Provider Demographics
NPI:1801805700
Name:ENDRES, MARY K (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:ENDRES
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 1:115 MEDICAL CIR
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-9003
Mailing Address - Country:US
Mailing Address - Phone:903-675-5742
Mailing Address - Fax:903-675-5677
Practice Address - Street 1:115 MEDICAL CIR
Practice Address - Street 2:SUITE 100B
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9003
Practice Address - Country:US
Practice Address - Phone:903-675-5742
Practice Address - Fax:903-675-5677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP0343Medicare ID - Type Unspecified
TXP64748Medicare UPIN