Individual
ANTAY LANE WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, CNM, WHNP
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-3595
Mailing address
1400 GROVELAND AVE, LONGVIEW, TX 75601-3811
(682) 500-0928
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
808428
TX
363LW0102X
Women's Health Nurse Practitioner
AP130426
TX
367A00000X
Advanced Practice Midwife
Primary
1030115
TX
Other
Enumeration date
02/03/2016
Last updated
07/07/2023
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