Healthcare Provider Details

I. General information

NPI: 1760834477
Provider Name (Legal Business Name): ALFREDIA MCDOWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 JOEY LN
ARLINGTON TX
76010-6336
US

IV. Provider business mailing address

2240 JOEY LN
ARLINGTON TX
76010-6336
US

V. Phone/Fax

Practice location:
  • Phone: 318-719-8702
  • Fax:
Mailing address:
  • Phone: 318-719-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: