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NPI Code Detail

MEDICARE: RHODA GWAN STEVENS FNP-BC

MEDICARE: RHODA GWAN STEVENS FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner822684TX

General Provider Information

NPI Number : 1033467477
Entity Type Code : Individual
Provider Name (Legal Business Name) : RHODA GWAN STEVENS FNP-BC
Provider Business Mailing Address
First Line : 6080 S HULEN STREET, STE 360
Second Line : PMB 198
City : FORT WORTH
State : TX
Zip : 76132-4810
Country : US
Telephone Number : 817-612-1551
Fax Number : 817-720-9989
Provider Business Practice Location Address
First Line : 6801 MCCART AVE STE 109
Second Line :
City : FORT WORTH
State : TX
Zip : 76133-6378
Country : US
Telephone Number : 817-612-1551
Fax Number : 817-720-9989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2012
Last Update Date : 10/07/2023

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