Warthan Dermatology Nacogdoches PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

WARTHAN DERMATOLOGY NACOGDOCHES PLLC

Practice address

4730 NE Stallings Dr
Nacogdoches, TX 75965-1615

Phone

(936) 564-6107

Fax

(936) 564-5124

NPI assigned

Oct 28, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jaclyn R Hill

Title

Practice Manager

Phone

(817) 923-8220

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amberly Hopson, FNP

  • Family Nurse Practitioner
  • Henderson, TX
  • NPI 1073940227
  Medicare reassignment Care Compare group NPD
• Molly Mae Warthan, M.D.

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1073773867
  Medicare reassignment Care Compare group NPD
• T Lynn Warthan, MD

  • Dermatology Physician
  • Nacogdoches, TX
  • NPI 1679647317
  Medicare reassignment Care Compare group NPD
• Lauren Davis, PA-C

  • Physician Assistant
  • Nacogdoches, TX
  • NPI 1114521366
  Medicare reassignment Care Compare group
• Katy Layne Boren, MPAS, PA-C

  • Physician Assistant
  • Cypress, TX
  • NPI 1740891225
  NPD (past)
• Cathleen Yvonne Chidester, PA-C

  • Medical Physician Assistant
  • Houston, TX
  • NPI 1134109432
  NPD (past)
• Stacy Elaine McEnaney, APRN-CNP

  • Family Nurse Practitioner
  • Houston, TX
  • NPI 1467958819
  NPD (past)
• Anthony Phan Nikko, MD

  • Dermatology Physician
  • Houston, TX
  • NPI 1962649491
  NPD (past)
• Vannica Soy, FNP-C

  • Dermatology Physician
  • Cypress, TX
  • NPI 1245843473
  NPD (past)
• Celia Marie Vaclavik, PA-C

  • Physician Assistant
  • Houston, TX
  • NPI 1164703393
  NPD (past)
• Crystal Whitby, PA

  • Medical Physician Assistant
  • Houston, TX
  • NPI 1922325414
  NPD (past)
• Russell Garcia Zamar, PA-C

  • Medical Physician Assistant
  • Houston, TX
  • NPI 1548066822
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678752000000",
    "number": "1144820135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4730 NE STALLINGS DR",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651615",
            "telephone_number": "817-923-8220",
            "fax_number": "817-923-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 NE STALLINGS DR",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651615",
            "telephone_number": "936-564-6107",
            "fax_number": "936-564-5124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARTHAN DERMATOLOGY NACOGDOCHES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-28",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "817-923-8220"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dayna Wall
• Gregory Scott Wallis, CRNA
• Tess Walters, PA-C
• Aisha Ligon Warfield, APRN
• Warthan Dermatology Center
• T Lynn Warthan, MD
• Melinda Watts, ATC
• Daniel Allison Weaver, D.D.S.,M.S
• Deana Marie Weaver
• Christy Michelle Webb, LMSW

• Dermatology Physician in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.