MEDICARE: AMY MICHELLE KOWALD FNP

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	363L00000X	Nurse Practitioner	AP142814	TX

General Provider Information

NPI Number	:	1245867563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MICHELLE KOWALD FNP

Provider Business Mailing Address
First Line	:	3804 TOWNBLUFF DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-8013
Country	:	US
Telephone Number	:	972-571-2352
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 HARVEST HILL RD STE 182
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1605
Country	:	US
Telephone Number	:	972-484-0040
Fax Number	:	972-484-0070

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

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	09/27/2021

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