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NPI Code Detail

MEDICARE: JOSHUA DAVID KNICKERBOCKER

MEDICARE: JOSHUA DAVID KNICKERBOCKER
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
1367500000XCertified Registered Nurse Anesthetist1225744TX

General Provider Information

NPI Number : 1386505543
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA DAVID KNICKERBOCKER
Provider Business Mailing Address
First Line : 3544 LANDY LN
Second Line :
City : RICHLAND HILLS
State : TX
Zip : 76118-5949
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4110
Country : US
Telephone Number : 817-926-2544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2025
Last Update Date : 01/27/2026

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Directions to “ JOSHUA DAVID KNICKERBOCKER ” Practice Location

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