Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 1046856 | TX |
NPI | 1043881238 |
---|---|
Provider Name | Alexis Winchester |
First Address | Fort Worth, TX 76116-9419 |
Second Address | Fort Worth, TX 76104-4139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 15/10/2021 |