Individual
RICHARD L. DEVAULT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
582140
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
AP111778
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1596884-03
—
TX
01
—
8N9010
BLUE SHIELD
TX
01
—
P00269393
RR/MEDICARE
TX
Enumeration date
04/05/2006
Last updated
01/11/2021
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