Stephanie Brooke Waldrep, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

345751 Issued in TX

Practice address

865 Brad St
Vidor, TX 77662-6651

Phone

(409) 658-9458

NPI assigned

Oct 30, 2018

Last updated

Oct 30, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1366919193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 BRAD ST",
            "city": "VIDOR",
            "state": "TX",
            "postal_code": "776626651",
            "telephone_number": "409-658-9458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 BRAD ST",
            "city": "VIDOR",
            "state": "TX",
            "postal_code": "776626651",
            "telephone_number": "409-658-9458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDREP",
        "first_name": "STEPHANIE",
        "middle_name": "BROOKE",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-30",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "TX",
            "license": "345751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vidor Isd
• Vidor Manor Inc (Legacy Living Centers)
• Vidor Manor Nursing Home Inc (Legacy Living Centers)
• Vidor Tso PA
• Wal-Mart Stores Texas LLC
• Walgreen Co (Walgreens #10139)
• Walgreens
• Brandy Lea Whisenant, LPCA
• Winnie Community Hospital, L.L.C. (Riceland Clinic)
• Crystal Young, NP

• Licensed Vocational Nurse in Vidor, TX
• Providers in Vidor, TX by specialty
• Licensed Vocational Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.