=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598614406
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANCEY ANDERSON FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2026
-----------------------------------------------------
Last Update Date | 01/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 729 GRAPEVINE HWY # 1050
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76054-2805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-669-2508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 729 GRAPEVINE HWY # 1050
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76054-2805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-669-2508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1225333
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------