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General NPI Number Information
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NPI Number | 1316443484
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Entity Type | Organization
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Legal Business Name | LESA G ANSELL
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 214 W BELT LINE RD STE A
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City | CEDAR HILL
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State | TX
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Zip | 75104-1105
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Country | US
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Telephone | 972-291-1992
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Fax | 972-637-7745
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Provider Business Mailing Address
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Address Line | 6080 S HULEN ST STE 360 PMB 232
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City | FORT WORTH
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State | TX
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Zip | 76132-4810
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Country | US
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Telephone | 214-732-8805
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Fax | 817-977-8981
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Authorized Official
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Title or Position | OWNER
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Name | LESA ANSELL
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Credential | APRN, AGNP-C, DC
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Telephone | 972-291-1992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP131295
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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