Cristy L Wallace
Nurse Practitioner Nutrition
1651 W Rosedale St Ste 205
Fort Worth
, Texas 76104-7437
Cristy L Wallace
Nurse Practitioner Nutrition
1651 W Rosedale St Ste 205
Fort Worth
, Texas 76104-7437
(817) 378-3699
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About
Features
Specialties
- Nutrition
- Nurse Practitioner
Languages spoken
- English
Location
First Address
- Cristy L Wallace
- Po Box 961205
- Fort Worth, TX
- Zip : 76161-0205
- Fax : (817) 378-3699
- Phone : (817) 740-8400
Second Address
- Cristy L Wallace
- 1651 W Rosedale St Ste 205
- Fort Worth, TX
- Zip : 76104-7437
- Fax : (817) 332-9977
- Phone : (817) 332-9966
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 111NN1001X | Nutrition | 7203 | TX |
| Y | 363L00000X | Nurse Practitioner | AP120370 | TX |
National Provider Identifier
| NPI | 1588959522 |
|---|---|
| Provider Name | Cristy L Wallace |
| First Address | Fort Worth, TX 76161-0205 |
| Second Address | Fort Worth, TX 76104-7437 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/06/2011 |
| Last Update Date | 13/08/2014 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.