MEDICARE: KELLEY DAWN WILCHER APRN, 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
1	363LF0000X	Family Nurse Practitioner	AP142250	TX

General Provider Information

NPI Number	:	1275186876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY DAWN WILCHER APRN, FNP-BC

Provider Business Mailing Address
First Line	:	1728 COUNTY ROAD 3791
Second Line	:
City	:	PARADISE
State	:	TX
Zip	:	76073-4922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6049 S HULEN ST
Second Line	:
City	:	FT. WORTH
State	:	TX
Zip	:	76132-4815
Country	:	US
Telephone Number	:	817-346-3313
Fax Number	:	817-346-3491

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	06/19/2024

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