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NPI Code Detail

MEDICARE: ANITA WILCOX

MEDICARE: ANITA WILCOX
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1740552884
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITA WILCOX
Provider Business Mailing Address
First Line : 11200 PLEASANT WOOD LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76140-6538
Country : US
Telephone Number : 817-253-0742
Fax Number :
Provider Business Practice Location Address
First Line : 6009 SHELTON ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-3934
Country : US
Telephone Number : 817-253-0742
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2012
Last Update Date : 02/27/2012

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Directions to “ ANITA WILCOX ” Practice Location

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