Provider Demographics
NPI:1699166025
Name:NEUROLOGICAL ASSOCIATES OF NORTH TEXAS
Entity type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-324-9301
Mailing Address - Street 1:9330 POPPY DR
Mailing Address - Street 2:SUITE 500B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4621
Mailing Address - Country:US
Mailing Address - Phone:214-324-9301
Mailing Address - Fax:
Practice Address - Street 1:7501 LAKEVEIW PARKWAY
Practice Address - Street 2:SUITE 245
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088
Practice Address - Country:US
Practice Address - Phone:214-324-9301
Practice Address - Fax:214-324-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN66872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330724Medicare PIN