Healthcare Provider Details

I. General information

NPI: 1174901748
Provider Name (Legal Business Name): AUBREY CHESNER PLOOF AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N UNIVERSITY DR
FORT WORTH TX
76107-1360
US

IV. Provider business mailing address

5100 EL CAMPO AVE
FORT WORTH TX
76107-4864
US

V. Phone/Fax

Practice location:
  • Phone: 817-814-2000
  • Fax:
Mailing address:
  • Phone: 817-504-2706
  • Fax: 817-378-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80761
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number80761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: