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Organization
VIDA KELLER RISTON RN CNM PC
Active
Organization
VIDA KELLER RISTON RN CNM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIDA RISTON FNP, CNM (CEO)
(409) 838-4472
Entity
Organization
Contact information
Practice address
2929 CALDER ST, BEAUMONT, TX 77702-1845
(409) 838-4472
(409) 838-0496
Mailing address
PO BOX 12667, BEAUMONT, TX 77726-2667
(409) 838-4472
(409) 838-0496
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
540793
TX
367A00000X
Advanced Practice Midwife
540793
TX
Other
Enumeration date
05/01/2013
Last updated
05/01/2013
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