MEDICARE: ALICIA NICOLE DEMITCHELL FNP-C

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	1130631	TX

General Provider Information

NPI Number	:	1588414494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA NICOLE DEMITCHELL FNP-C

Provider Business Mailing Address
First Line	:	321 ALLENWOOD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-5356
Country	:	US
Telephone Number	:	616-690-8638
Fax Number	:

Provider Business Practice Location Address
First Line	:	3051 S CENTER ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2023
Country	:	US
Telephone Number	:	817-468-1818
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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