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General NPI Number Information
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NPI Number | 1962985903
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Entity Type | Individual
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Provider Name | BOBBIE JO DEWEESE RN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 279 W HIDDEN CREEK PKWY STE 1209
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City | BURLESON
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State | TX
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Zip | 76028
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Country | US
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Telephone | 817-629-2616
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Fax | 817-662-6255
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Provider Business Mailing Address
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Address Line | 279 W HIDDEN CREEK PKWY STE 1209
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City | BURLESON
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State | TX
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Zip | 76028-6077
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Country | US
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Telephone | 817-629-2616
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Fax | 817-662-6255
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP138096
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP138096
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 830038
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License Number State | TX
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