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General NPI Number Information
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NPI Number | 1558185496
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Entity Type | Individual
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Provider Name | ALEXIS CALVILLO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 900 W MAGNOLIA AVE STE 201&203
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City | FORT WORTH
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State | TX
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Zip | 76104-8517
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Country | US
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Telephone | 817-912-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 CASH ST
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City | BURLESON
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State | TX
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Zip | 76028-4134
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Country | US
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Telephone | 817-774-0260
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1177522
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License Number State | TX
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