Individual
CRISTY L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1651 W ROSEDALE ST STE 205, FORT WORTH, TX 76104-7437
(817) 332-9966
(817) 332-9977
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-0205
(817) 740-8400
(817) 378-3699
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
7203
TX
133N00000X
Nutritionist
—
TX
363L00000X
Nurse Practitioner
Primary
AP120370
TX
Other
Enumeration date
06/17/2011
Last updated
08/13/2014
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