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General NPI Number Information
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NPI Number | 1649638776
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Entity Type | Individual
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Provider Name | ANTAY LANE WATERS DNP, APRN, CNM, WHNP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 817-702-3595
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 GROVELAND AVE
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City | LONGVIEW
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State | TX
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Zip | 75601-3811
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Country | US
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Telephone | 682-500-0928
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 808428
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP130426
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 1030115
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License Number State | TX
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