# FORT PHYSICIANS & PROFESSIONALS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750900478
- **Authorized official:** ALICE ANN KUCHINSKAS (PAYER RELATIONS)
- **Authorized official phone:** (562) 544-7823

## Contact information

- **Practice address:** 5833 OAK BEND TRAIL, FORT WORTH, TX 76132-3900
- **Practice address phone:** (817) 678-7428
- **Practice address fax:** (682) 707-5750
- **Mailing address:** 7140 OAKMONT BLVD., FORT WORTH, TX 76132-3900
- **Mailing address phone:** (625) 447-8235
- **Mailing address fax:** (949) 485-6212

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | — |
| 103K00000X | Behavior Analyst | — | — | — |
| 2080P0006X | Developmental - Behavioral Pediatrics Physician | — | NULL | — |
| 2080P0006X | Developmental - Behavioral Pediatrics Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/13/2020
- **Last updated:** 04/13/2020