1. Home
  2. Directory
  3. Texas
  4. Canyon
  5. Nurse Practitioner
  6. NPI Profile

FAITH MEDICAL CLINIC, PLLC
NPI 1417368168
Nurse Practitioner - Family in Canyon, TX

Active since May 15, 2014
1619 4TH AVE, CANYON, TX 79015(806) 557-4138(806) 557-4165 Get Directions Write a Review

NPPES record last updated: March 2, 2022. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Faith Medical Clinic, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAITH MEDICAL CLINIC, PLLC (NPI 1417368168) is a healthcare organization registered as a family in Canyon, Texas and active in the NPI registry since May 2014. The organization maintains a secondary practice location in Canyon and lists Gloria R Fuller, Owner, as its authorized official.

NPPES Registry Identity

NPI1417368168
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameFAITH MEDICAL CLINIC, PLLC
Location Address1619 4TH AVECanyon, TX 79015-3824
Mailing AddressPo Box 1614Canyon, TX 79015-1614 · (806) 557-4138 · Fax (806) 557-4165
Phone(806) 557-4138
Fax(806) 557-4165
Organization SubpartNo
Authorized OfficialGloria R FullerOwner · (806) 557-4138
Enumeration DateMay 15, 2014
Last NPPES UpdateMarch 2, 2022
NPPES CertifiedMarch 2, 2022
✔ NPI 1417368168 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in TX · AP118557
1619 4TH AVE, Canyon, TX 79015
Open in Google Maps ↗

Secondary Practice Location 1

Location 11205 23rd St Ste 5Canyon, TX 79015-5331 · Phone (806) 557-4674

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2082097

Faith Medical Clinic · Canyon, TX
Expired · Aug 5, 2026
CLIA Number45D2082097
Laboratory TypePhysician Office
Certificate Effective DateAugust 6, 2024
Certificate Expiration DateAugust 5, 2026
Laboratory DirectorGloria R. Fuller
Laboratory Phone(806) 557-4674
Laboratory LocationFaith Medical Clinic1205 23rd St Suite 6, Canyon, TX 79015
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JAMES ROSSON FNP-C
Nurse Practitioner (Family)
1619 4TH AVE
CANYON, TX 79015
Randall County (806) 557-4674
MRS. GLORIA LEWIS FNP
Nurse Practitioner (Family)
1619 4TH AVE
CANYON, TX 79015
Randall County (806) 557-4138
CROSS MEDICAL CLINIC PLLC
Nurse Practitioner (Family)
1619 4TH AVE
CANYON, TX 79015
Randall County (806) 418-5880
JENNIFER BROWN APRN, FNP-C
Nurse Practitioner (Family)
1619 4TH AVE
CANYON, TX 79015
Randall County (806) 557-4674
SARAH ELIZABETH CARLISLE FNP-C
Nurse Practitioner
1619 4TH AVE
CANYON, TX 79015
Randall County (806) 557-4674

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Faith Medical Clinic, PLLC's NPI number?

The NPI number for Faith Medical Clinic, PLLC is 1417368168. It was assigned to this organization in the NPPES registry on May 15, 2014.

Where is Faith Medical Clinic, PLLC located?

Faith Medical Clinic, PLLC is located at 1619 4th Ave, Canyon, TX 79015. The listed phone number is (806) 557-4138.

What is Faith Medical Clinic, PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

What insurance does Faith Medical Clinic, PLLC accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma list Faith Medical Clinic, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Faith Medical Clinic, PLLC was last updated on March 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.