Individual
JOANNE DISPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-PMHNP
Contact information
Practice address
601 W TERRELL AVE, FORT WORTH, TX 76104-3243
(817) 702-3100
Mailing address
1200 CIRCLE DR, SUITE 400B, FORT WORTH, TX 76119-8112
(817) 569-4750
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
730584
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331002101
—
TX
01
—
331002102
CSHCN MEDICAID
TX
01
—
8177NF
BLUE CROSS BLUE SHIELD
TX
Enumeration date
10/23/2013
Last updated
04/28/2022
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