Provider Demographics
NPI:1992524714
Name:BAIN, VANESSA DAWN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:DAWN
Last Name:BAIN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-785-0334
Mailing Address - Fax:
Practice Address - Street 1:11011 SLIDE RD STE 2140W
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2274
Practice Address - Country:US
Practice Address - Phone:806-472-6699
Practice Address - Fax:806-472-6698
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176468363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner