Healthcare Provider Details

I. General information

NPI: 1730168501
Provider Name (Legal Business Name): BECKY WIGHTMAN ALTHAUS RN, PH.D., CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA WIGHTMAN ALTHAUS APRN, PH.D., FNP-BC

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 8TH AVE STE 200
FORT WORTH TX
76104-2500
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-2170
  • Fax: 817-335-8277
Mailing address:
  • Phone: 682-885-1855
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number270.1006
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number230870
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP121066
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: