Healthcare Provider Details

I. General information

NPI: 1982292231
Provider Name (Legal Business Name): CODY LASHAY ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CODY LASHAY ANDERSON RN, BSN

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 WESTERN CENTER BLVD
FORT WORTH TX
76137-2036
US

IV. Provider business mailing address

2004 EDMONIA CT
FORT WORTH TX
76105-2821
US

V. Phone/Fax

Practice location:
  • Phone: 817-232-1634
  • Fax:
Mailing address:
  • Phone: 817-209-9103
  • Fax: 281-606-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number912117
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number912117
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: