Provider Demographics
NPI:1528243524
Name:SAVAHL, FREDA CECELIA
Entity type:Individual
Prefix:MS
First Name:FREDA
Middle Name:CECELIA
Last Name:SAVAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848268
Mailing Address - Street 2:ATT IPM CREDENTIALING
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8268
Mailing Address - Country:US
Mailing Address - Phone:903-416-1726
Mailing Address - Fax:903-416-1701
Practice Address - Street 1:1900 SE 34TH AVE
Practice Address - Street 2:UNIT 1800
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-7771
Practice Address - Country:US
Practice Address - Phone:806-351-7540
Practice Address - Fax:806-351-7546
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-365364SW0102X
TX449655363LW0102X
TXAP104182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0707739-03Medicaid
TX0707739-03Medicaid
TX263703ZHHLMedicare PIN