Provider Demographics
NPI:1902807043
Name:POKORNY, DAVID M (DC, FNP-C)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:POKORNY
Suffix:
Gender:M
Credentials:DC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 W. MORTON
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1623
Mailing Address - Country:US
Mailing Address - Phone:903-465-2225
Mailing Address - Fax:903-465-1162
Practice Address - Street 1:2214 W. MORTON
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1623
Practice Address - Country:US
Practice Address - Phone:903-465-2225
Practice Address - Fax:903-465-1162
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX792625363LF0000X, 363LF0000X
TX4604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX602063OtherBLUE CROSS/BLUE SHEILD TX
TX752328635OtherTAX ID#
TX5679361OtherAETNA
TX5679361OtherAETNA
TXT79073Medicare UPIN