Healthcare Provider Details

I. General information

NPI: 1518789577
Provider Name (Legal Business Name): GITA DEVI SUBEDI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEDICAL CENTER DR STE C
DECATUR TX
76234-3844
US

IV. Provider business mailing address

1009 CUSHING DR
FORT WORTH TX
76177-1694
US

V. Phone/Fax

Practice location:
  • Phone: 940-626-2110
  • Fax:
Mailing address:
  • Phone: 720-768-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1035039
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: