Stormi Breann Waddell, RN, BSN

Key facts

NPI

1376175653

Entity type

Individual (NPI type 1)

Primary specialty

Registered Nurse 163W00000X

License

981816 (TX)

Practice address

12304 Blackman Rd
Diana, TX 75640-3421

Phone

(903) 305-2490

NPI assigned

Feb 5, 2020

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 5, 2020.

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1376175653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12304 BLACKMAN RD",
            "city": "DIANA",
            "state": "TX",
            "postal_code": "756403421",
            "telephone_number": "903-305-2490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "STORMI",
        "middle_name": "BREANN",
        "credential": "RN, BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-05",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "981816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Diana, TX

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• New Diana Isd
• Kristin Nichole Nieland
• Alexis Christine Ormes, ND
• Teresa M Phillips, PTA
• Kristy Michelle Ward
• Crystal Whitfield

All providers in Diana, TX · Registered Nurse in Texas