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NPI Code Detail

MEDICARE: DA'RESSA ANDREWS

MEDICARE: DA'RESSA ANDREWS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246Z00000XOther Specialist/Technologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11111111111OTHERTXNOT APPLICABLE

General Provider Information

NPI Number : 1053995381
Entity Type Code : Individual
Provider Name (Legal Business Name) : DA'RESSA ANDREWS
Provider Business Mailing Address
First Line : 111 BOLAND ST STE 211
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-1265
Country : US
Telephone Number : 817-529-8514
Fax Number : 469-453-5075
Provider Business Practice Location Address
First Line : 111 BOLAND ST STE 211
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-1265
Country : US
Telephone Number : 817-529-8514
Fax Number : 469-453-5075
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2021
Last Update Date : 05/12/2021

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Directions to “ DA'RESSA ANDREWS ” Practice Location

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