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Individual

CORTNEY FANNING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
150 RIVER NORTH BLVD, STEPHENVILLE, TX 76401-1860
(254) 968-6051
(254) 968-4950
Mailing address
P.O. BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8450

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP138958
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
391130701
TX
Enumeration date
09/28/2018
Last updated
09/20/2019
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