MEDICARE: WHITNEY GULDE PA

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	363A00000X	Physician Assistant	PA09921	TX
2	363A00000X	Physician Assistant		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891176079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY GULDE PA

Provider Business Mailing Address
First Line	:	2425 HIGHWAY 121
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-5011
Country	:	US
Telephone Number	:	817-540-4477
Fax Number	:	817-540-5633

Provider Business Practice Location Address
First Line	:	3301 GOLDEN TRIANGLE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7165
Country	:	US
Telephone Number	:	817-540-4477
Fax Number	:	817-540-5633

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

Provider Enumeration Date	:	06/14/2015
Last Update Date	:	01/28/2023

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1265546618 — ASHLEY MYRIAH JOHNSON D.O.
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Directions to “ WHITNEY GULDE PA” Practice Location

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