Individual
CONNIE E DEDMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
4405 RIVER OAKS BLVD, FORT WORTH, TX 76114-2326
(817) 624-1770
(817) 625-1287
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
230593
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750369203
GROUP NPI
—
05
—
184937401
—
TX
05
—
184937403
—
TX
Enumeration date
12/07/2005
Last updated
04/03/2012
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