MEDICARE: RACHAUN DAMITA LLOYD RN

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
1	163WC1500X	Community Health Registered Nurse	1015331	TX

General Provider Information

NPI Number	:	1063377166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAUN DAMITA LLOYD RN

Provider Business Mailing Address
First Line	:	9509 BELLE RIVER TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9509 BELLE RIVER TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1814
Country	:	US
Telephone Number	:	405-968-7162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	12/20/2025

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