Mrs. Amy Michelle Medalie
Nurse Practitioner - Pediatrics
4405 River Oaks Blvd
Fort Worth
, Texas 76114-2326
Mrs. Amy Michelle Medalie
Nurse Practitioner - Pediatrics
4405 River Oaks Blvd
Fort Worth
, Texas 76114-2326
(682) 885-1855
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About
Features
Specialties
- Nurse Practitioner - Pediatrics
Languages spoken
- English
Location
First Address
- Mrs. Amy Michelle Medalie
- Po Box 733784
- Dallas, TX
- Zip : 75373-3784
- Phone : (682) 885-1855
Second Address
- Mrs. Amy Michelle Medalie
- 4405 River Oaks Blvd
- Fort Worth, TX
- Zip : 76114-2326
- Fax : (817) 625-1287
- Phone : (817) 624-1770
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0200X | Nurse Practitioner - Pediatrics | 6037 | CO |
National Provider Identifier
| NPI | 1003045204 |
|---|---|
| Provider Name | Mrs. Amy Michelle Medalie |
| First Address | Dallas, TX 75373-3784 |
| Second Address | Fort Worth, TX 76114-2326 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 08/07/2009 |
| Last Update Date | 07/04/2021 |
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.