MEDICARE: LYDIA AMARTEY 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	773090	TX

General Provider Information

NPI Number	:	1871919860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA AMARTEY FNP-C

Provider Business Mailing Address
First Line	:	1097 LUTON DR
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-5663
Country	:	US
Telephone Number	:	972-838-3096
Fax Number	:

Provider Business Practice Location Address
First Line	:	14525 MCCARRAN AVE
Second Line	:	APT 6307
City	:	FORT WORTH
State	:	TX
Zip	:	76155-3045
Country	:	US
Telephone Number	:	972-838-3096
Fax Number	:

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

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	07/12/2019

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