MEDICARE: MS. ANDREA E. CHENEWETH 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	363LF0000X	Family Nurse Practitioner	635486	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	635486	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1275548109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA E. CHENEWETH FNP

Provider Business Mailing Address
First Line	:	6250 JOHN RYAN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4115
Country	:	US
Telephone Number	:	817-346-9800
Fax Number	:	817-346-9881

Provider Business Practice Location Address
First Line	:	6250 JOHN RYAN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4115
Country	:	US
Telephone Number	:	817-346-9800
Fax Number	:	817-346-9881

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/08/2007

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