Individual
MRS. AMY MICHELLE MEDALIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4405 RIVER OAKS BLVD, FORT WORTH, TX 76114-2326
(817) 624-1770
(817) 625-1287
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-1855
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
6037
CO
Other
Enumeration date
07/08/2009
Last updated
04/07/2021
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