MEDICARE: MRS. DEBBIE NHUNG PHAM NURSE PRACTITIONER

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
1	363LF0000X	Family Nurse Practitioner	1125290	TX

General Provider Information

NPI Number	:	1215611314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBBIE NHUNG PHAM NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1512 LOWES FARM PKWY
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-8616
Country	:	US
Telephone Number	:	817-455-3385
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 N BEACH ST STE 108
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1507
Country	:	US
Telephone Number	:	817-984-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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