Active NPI
Stephanie Renee Waterman, D.O.
- Family Medicine Physician
- Allen, TX
National Provider Identifier
1639246283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- K9699
- Practice address
- 1520 Farm DL
Allen, TX 75002-1551 - Phone
- (972) 849-3280
- NPI assigned
- Nov 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | K9699 | TX | Primary |
Addresses
Primary practice location
1520 Farm DL
Allen, TX 75002-1551
Mailing address
1520 Farm DL
Allen, TX 75002-1551
Phone (972) 849-3280
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8A1395 | Other | TX | BCBS |
| 2204144 | Other | TX | UNITED |
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| K9699 | TX | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287360000000",
"number": "1639246283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1520 FARM DL",
"city": "ALLEN",
"state": "TX",
"postal_code": "750021551",
"telephone_number": "972-849-3280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1520 FARM DL",
"city": "ALLEN",
"state": "TX",
"postal_code": "750021551",
"telephone_number": "972-849-3280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERMAN",
"first_name": "STEPHANIE",
"middle_name": "RENEE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2010-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "K9699",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8A1395",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED",
"identifier": "2204144",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Allen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.