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NPI Code Detail

MEDICARE: MISTY LEANN SIDES CPNP-AC

MEDICARE: MISTY LEANN SIDES CPNP-AC
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
1363LP0222XCritical Care Pediatric Nurse PractitionerAPRN11036871FL
2363LA2100XAcute Care Nurse Practitioner1179271TX

General Provider Information

NPI Number : 1477371474
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY LEANN SIDES CPNP-AC
Provider Business Mailing Address
First Line : PO BOX 733784
Second Line :
City : DALLAS
State : TX
Zip : 75373-3784
Country : US
Telephone Number : 682-885-6483
Fax Number : 682-885-3113
Provider Business Practice Location Address
First Line : 1500 COOPER ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2710
Country : US
Telephone Number : 682-885-7770
Fax Number : 682-303-0893
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2024
Last Update Date : 04/08/2026

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Directions to “ MISTY LEANN SIDES CPNP-AC” Practice Location

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