MEDICARE: MRS. MARY ALICE PHIFER RN C 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	435681	TX

General Provider Information

NPI Number	:	1336218908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ALICE PHIFER RN C FNP

Provider Business Mailing Address
First Line	:	4738 LITTLE ROAD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017
Country	:	US
Telephone Number	:	817-483-8599
Fax Number	:	817-483-2440

Provider Business Practice Location Address
First Line	:	4738 LITTLE ROAD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017
Country	:	US
Telephone Number	:	817-483-8599
Fax Number	:	817-483-2440

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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