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General NPI Number Information
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NPI Number | 1093050940
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Entity Type | Organization
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Legal Business Name | FYATT HEALTHCARE
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 1608 WINDSONG TRL 615
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City | FORT WORTH
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State | TX
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Zip | 76120-4223
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Country | US
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Telephone | 267-872-9756
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 WINDSONG TRL 615
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City | FORT WORTH
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State | TX
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Zip | 76120-4223
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Country | US
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Telephone | 267-872-9756
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. OLUWAYEMISI AGBOOLA
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Credential | FNP
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Telephone | 267-872-9756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 798898
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License Number State | TX
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