Provider Demographics
NPI:1982069316
Name:MISSILDINE, VIRGINIA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIE
Last Name:MISSILDINE
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:PO BOX 2709
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606
Mailing Address - Country:US
Mailing Address - Phone:903-792-5924
Mailing Address - Fax:903-792-8224
Practice Address - Street 1:1102 MAIN STREET
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501
Practice Address - Country:US
Practice Address - Phone:903-792-5924
Practice Address - Fax:903-792-8224
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129782363LF0000X
ARA005417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily