Provider Demographics
NPI:1982701090
Name:WATERS, LINDA JANE (CFNP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JANE
Last Name:WATERS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 10TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5037
Mailing Address - Country:US
Mailing Address - Phone:940-687-5000
Mailing Address - Fax:940-687-4000
Practice Address - Street 1:1709 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5037
Practice Address - Country:US
Practice Address - Phone:940-687-5000
Practice Address - Fax:940-687-4000
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0406049363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0406049OtherNURSE PRACTITIONER CERTIF