Healthcare Provider Details

I. General information

NPI: 1447042270
Provider Name (Legal Business Name): AMIE JAYDE CALHOUN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 FAIRMOUNT AVE
FORT WORTH TX
76104-4215
US

IV. Provider business mailing address

1201 FAIRMOUNT AVE
FORT WORTH TX
76104-4215
US

V. Phone/Fax

Practice location:
  • Phone: 817-335-5288
  • Fax: 817-338-0927
Mailing address:
  • Phone: 817-335-5288
  • Fax: 817-338-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number959532
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1206991
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1206991
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1206991
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: