MEDICARE: MS. MARY ELIZABETH VIGLAS-ECKLES APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1200585	TX

General Provider Information

NPI Number	:	1184417818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELIZABETH VIGLAS-ECKLES APRN

Provider Business Mailing Address
First Line	:	1408 PALAMEDES DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-4761
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 S HULEN ST STE 124-742
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1914
Country	:	US
Telephone Number	:	817-674-2815
Fax Number	:	817-510-0870

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

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	01/05/2026

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