Healthcare Provider Details

I. General information

NPI: 1992452346
Provider Name (Legal Business Name): ALEXANDRIA WARE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 03/06/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 W AMARILLO BLVD
AMARILLO TX
79106-1755
US

IV. Provider business mailing address

PO BOX 840026
DALLAS TX
75284-0026
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-4535
  • Fax: 806-212-4555
Mailing address:
  • Phone: 806-212-5079
  • Fax: 806-212-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1032838
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: