MEDICARE: SHICOBIE ADAMS FNP-C

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	745607	TX

General Provider Information

NPI Number	:	1902239387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHICOBIE ADAMS FNP-C

Provider Business Mailing Address
First Line	:	6020 FLAT WOOD LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-3100
Country	:	US
Telephone Number	:	972-977-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 MITCHELL BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-4642
Country	:	US
Telephone Number	:	817-916-4333
Fax Number	:	817-916-4338

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

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	04/23/2014

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