Provider Demographics
NPI:1609001643
Name:FORD, TRASA RYNETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:TRASA
Middle Name:RYNETTE
Last Name:FORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3122
Mailing Address - Country:US
Mailing Address - Phone:713-501-9703
Mailing Address - Fax:
Practice Address - Street 1:4 LAKE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3122
Practice Address - Country:US
Practice Address - Phone:713-501-9703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669199163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant