Individual provider Active NPI

Mary Farrar

  • Licensed Practical Nurse
  • Tyler, TX
National Provider Identifier
1407439557
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
123086 Issued in AR
Practice address
755 S Beckham Ave
Tyler, TX 75701-1903
Phone
(903) 534-4684
NPI assigned
May 5, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 123086 AR Primary

Addresses

Primary practice location

755 S Beckham Ave
Tyler, TX 75701-1903

Mailing address

755 S Beckham Ave
Tyler, TX 75701-1903
Phone (903) 534-4684

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
123086ARMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1407439557",
    "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",
            "telephone_number": "903-534-4684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011903",
            "telephone_number": "903-534-4684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARRAR",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-05",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AR",
            "license": "123086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; 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.