MEDICARE: ALEXIS VAN PELT

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1710833363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS VAN PELT

Provider Business Mailing Address
First Line	:	900 CINEMA DR APT 2329
Second Line	:
City	:	HUDSON OAKS
State	:	TX
Zip	:	76087-2251
Country	:	US
Telephone Number	:	918-645-7054
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2644
Country	:	US
Telephone Number	:	817-735-2000
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ ALEXIS VAN PELT ” Practice Location

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