MEDICARE: MRS. DEBORAH RADAFORD FNP-C, AAHIVMS

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	248359	TX

General Provider Information

NPI Number	:	1942434758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH RADAFORD FNP-C, AAHIVMS

Provider Business Mailing Address
First Line	:	1101 S MAIN ST
Second Line	:	ROOM 1500
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4802
Country	:	US
Telephone Number	:	817-321-4850
Fax Number	:	817-321-4809

Provider Business Practice Location Address
First Line	:	1101 S MAIN ST
Second Line	:	ROOM 1500
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4802
Country	:	US
Telephone Number	:	817-321-4850
Fax Number	:	817-321-4809

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

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	03/19/2013

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