Individual
MISTIE B. GRANBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1250 8TH AVE STE 240, FORT WORTH, TX 76104-4139
(817) 927-0456
(817) 927-4323
Mailing address
P.O. BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 927-4323
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP125723
TX
Other
Enumeration date
07/24/2014
Last updated
07/25/2014
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