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General NPI Number Information
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NPI Number | 1366248890
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Entity Type | Individual
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Provider Name | LANDRIA NICOLE MCINTYRE WHNP
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1200 HIGHWAY 287 N STE 103
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City | MANSFIELD
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State | TX
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Zip | 76063-2874
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Country | US
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Telephone | 817-473-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 610 DOVE CREEK PARK
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-1790
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Country | US
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Telephone | 901-598-3918
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 1142324
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License Number State | TX
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