Provider Demographics
NPI:1861092470
Name:VALLASTER, JAMES HOMER (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HOMER
Last Name:VALLASTER
Suffix:
Gender:M
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7061
Mailing Address - Country:US
Mailing Address - Phone:254-998-0794
Mailing Address - Fax:
Practice Address - Street 1:825 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7061
Practice Address - Country:US
Practice Address - Phone:254-998-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily