CROSS MEDICAL CLINIC PLLC (NPI# 1366879314) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366879314 |
| Entity Type | Organization |
| Organization Name | CROSS MEDICAL CLINIC PLLC |
| Practice Address |
1619 4th Ave Canyon TX 79015-3824 |
| Mailing Address |
Po Box 1614 Canyon TX 79015-1614 |
| Practice Telephone | 8064185880 |
| Mailing Telephone | 8065574138 |
| Mailing Fax Number | 8065574165 |
| Enumeration Date | 2013-10-06 |
| Last Update Date | 2013-10-14 |
| Authorized Official Name | MRS. GLORIA RODRIGUEZ FULLER (OWNER) |
| Authorized Official Telephone | 8064185880 |
| Authorized Official Credential | FNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
694365 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1619 4TH AVE |
| City | CANYON |
| State | TX |
| Zip Code | 79015-3824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245460625 | Gloria Lewis | Nurse Practitioner | 1619 4th Ave, Canyon, TX 79015 | 2009-07-21 |
| 1043820830 | James Rosson | Nurse Practitioner | 1619 4th Ave, Canyon, TX 79015-3824 | 2020-08-05 |
| 1962010892 | Sarah Elizabeth Carlisle | Nurse Practitioner | 1619 4th Ave, Canyon, TX 79015-3824 | 2020-07-16 |
| 1114473659 | Ginger Jendro | Nurse Practitioner | 1619 4th Ave, Canyon, TX 79015-3824 | 2016-08-25 |
| 1417368168 | Faith Medical Clinic, Pllc | Nurse Practitioner | 1619 4th Ave, Canyon, TX 79015-3824 | 2014-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194195826 | Melani Kelly | Specialist/Technologist | 702 3rd Avenue, Canyon, TX 79015 | 2015-10-07 |
| 1063846111 | Erin Ann Park | Physical Medicine & Rehabilitation | 907 23rd St., Canyon, TX 79015 | 2013-08-26 |
| 1003177197 | True Blessings LLC | Home Health | 1317 4th Avenue, Canyon, TX 79015 | 2012-06-05 |
| 1376669861 | Assisted Living Concepts Inc | Assisted Living Facility | 2 Cottonwood Lane, Canyon, TX 79015 | 2007-03-22 |
| 1376568642 | D'aun Chrie Bowers | Emergency Medicine | 500 20th St, Canyon, TX 79015 | 2006-07-13 |
| 1760931497 | Kershen Health Services | Physical Therapist | 1613 4th Ave, Canyon, TX 79015 | 2016-09-22 |
| 1568730034 | Katherine Sheri Rogers | Physical Therapist | 15 Hospital Drive, Canyon, TX 79015 | 2011-12-12 |
| 1437273158 | Tommy W Brian I | Nurse Practitioner | 911 23rd St, Canyon, TX 79015 | 2007-03-19 |
| 1194377754 | Emily Collins | Occupational Therapist | 18 Case Ln, Canyon, TX 79015-1796 | 2019-07-14 |
| 1134249162 | Educare Community Living Limited Partnership | Intermediate Care Facility, Mentally Retarded | 4 Idlewood Ln, Canyon, TX 79015-2027 | 2007-03-31 |
| Find all providers in zip 79015 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104431238 | Candice Martin Taylor | Nurse Practitioner | 4 Neely Ln, Canyon, TX 79015-6470 | 2020-09-15 |
| 1215433941 | Teresa Diane Smoot | Nurse Practitioner | 2403 Russell Long Blvd, Canyon, TX 79016-0005 | 2018-04-02 |
| 1730454240 | Stephanie Suzanne Macklin | Nurse Practitioner | 1101 4th Ave, Canyon, TX 79015-3701 | 2012-03-16 |
| 1245460625 | Gloria Lewis | Nurse Practitioner | 1619 4th Ave, Canyon, TX 79015 | 2009-07-21 |
| 1245341692 | Wendy L Bertram | Nurse Practitioner | 2620 N. Russell Long Blvd, Canyon, TX 79016-0001 | 2006-08-31 |
| 1376526129 | Karen Elizabeth Knapp | Nurse Practitioner | Wt Box 61401, Canyon, TX 79016-0001 | 2005-11-25 |
| 1043820830 | James Rosson | Nurse Practitioner | 1619 4th Ave, Canyon, TX 79015-3824 | 2020-08-05 |
| 1689283293 | April Oliver | Nurse Practitioner | 911 23rd St, Canyon, TX 79015-4645 | 2020-07-29 |
| 1962010892 | Sarah Elizabeth Carlisle | Nurse Practitioner | 1619 4th Ave, Canyon, TX 79015-3824 | 2020-07-16 |
| 1710534607 | Kaitlyn Wynne | Nurse Practitioner | 301 N 23rd St Ste C, Canyon, TX 79015-3058 | 2019-08-25 |
| Find all providers in CANYON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.