Healthcare Provider Details

I. General information

NPI: 1619738457
Provider Name (Legal Business Name): GABRIELA PACHECO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 WESTSIDE DR STE 200
DECATUR TX
76234-3869
US

IV. Provider business mailing address

324 EASTLAND LN
WICHITA FALLS TX
76305-7283
US

V. Phone/Fax

Practice location:
  • Phone: 940-273-5700
  • Fax: 940-273-5699
Mailing address:
  • Phone: 918-850-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1150312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: