Provider Demographics
NPI:1831515667
Name:STATEN, DAVID (APRN; A/G ACNP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STATEN
Suffix:
Gender:M
Credentials:APRN; A/G ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 NEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ZULCH
Mailing Address - State:TX
Mailing Address - Zip Code:77872-6337
Mailing Address - Country:US
Mailing Address - Phone:281-740-2405
Mailing Address - Fax:
Practice Address - Street 1:700 SCOTT AND WHITE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6441
Practice Address - Country:US
Practice Address - Phone:979-207-0100
Practice Address - Fax:979-207-2161
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX663393163W00000X
TXAP125278363LC0200X, 363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01402891OtherRR MEDICARE
TX8889NJOtherBLUE CROSS BLUE SHIELD
TX364083YMVQMedicare PIN