Healthcare Provider Details

I. General information

NPI: 1538870977
Provider Name (Legal Business Name): NIKYSHA LYNETTE FRANCISCO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W TERRELL AVE STE K230
FORT WORTH TX
76104-3104
US

IV. Provider business mailing address

9732 HATHMAN LN
FORT WORTH TX
76244-9555
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-4906
  • Fax:
Mailing address:
  • Phone: 469-360-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number869872
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1103261
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: