MEDICARE: RASHONDA L WAITES NP

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	363L00000X	Nurse Practitioner	1170962	TX
2	363LP2300X	Primary Care Nurse Practitioner	1170962	TX

General Provider Information

NPI Number	:	1982432449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASHONDA L WAITES NP

Provider Business Mailing Address
First Line	:	4701 BOAT CLUB RD STE 325
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2120
Country	:	US
Telephone Number	:	817-238-1950
Fax Number	:	817-238-1975

Provider Business Practice Location Address
First Line	:	4701 BOAT CLUB RD STE 325
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2120
Country	:	US
Telephone Number	:	817-238-1950
Fax Number	:

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

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	03/05/2026

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