| Valiant Life Medical Pllc | |
|
4830 South Fwy Fort Worth TX 76115-3901 | |
| (817) 926-0012 | |
| (817) 927-0533 |
| Full Name | Valiant Life Medical Pllc |
|---|---|
| Speciality | General Practice |
| Location | 4830 South Fwy, Fort Worth, Texas |
| Authorized Official Name and Position | James Matthew Jernigan (CHIROPRACTOR) |
| Authorized Official Contact | 8179260012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valiant Life Medical Pllc 4830 South Fwy Fort Worth TX 76115-3901 Ph: (817) 926-0012 | Valiant Life Medical Pllc 4830 South Fwy Fort Worth TX 76115-3901 Ph: (817) 926-0012 |
| NPI Number | 1043702095 |
|---|---|
| Provider Enumeration Date | 06/05/2018 |
| Last Update Date | 02/08/2019 |
| Medicare PECOS PAC ID | 6305182593 |
|---|---|
| Medicare Enrollment ID | O20190109000703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043702095 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | N1889 (Texas) | Primary |
| Provider Name | Neeraj Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205968757 PECOS PAC ID: 3779661343 Enrollment ID: I20091201000430 |
| Provider Name | Lara Kunowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477045599 PECOS PAC ID: 5395093025 Enrollment ID: I20180813000640 |
| Provider Name | James M Jernigan |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1588773469 PECOS PAC ID: 8123365673 Enrollment ID: I20190211000219 |
| Provider Name | Jordan L Haney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891313037 PECOS PAC ID: 8325454168 Enrollment ID: I20210303000692 |
| Provider Name | Nolan A Smith |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1629635677 PECOS PAC ID: 4587070271 Enrollment ID: I20210303003018 |
| Provider Name | Cindy L Bernard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285240077 PECOS PAC ID: 6305253253 Enrollment ID: I20210322001247 |
| Provider Name | Elizabeth Vergara Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912652637 PECOS PAC ID: 2163804030 Enrollment ID: I20220809003111 |
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