Individual
KATHY DIANE WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
1200 COUNTRY CLUB LN, FORT WORTH, TX 76112-2353
(817) 451-1404
Mailing address
1200 COUNTRY CLUB LN, FORT WORTH, TX 76112-2353
(817) 451-1404
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
436807
TX
Other
Enumeration date
02/12/2009
Last updated
02/12/2009
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