MEDICARE: ALICE ANN BAGBY FNP

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	1114691	TX

General Provider Information

NPI Number	:	1972298842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE ANN BAGBY FNP

Provider Business Mailing Address
First Line	:	230 O CONNOR RIDGE BLVD STE 110
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6513
Country	:	US
Telephone Number	:	214-666-6259
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 W LAMPASAS ST
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-4533
Country	:	US
Telephone Number	:	214-666-6259
Fax Number	:

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

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	02/04/2026

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