Individual
ASHLEY LYNETTE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-C,
Contact information
Practice address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 922-4630
Mailing address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 922-4630
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP141896
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
PENDING
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP141896
TEXAS BOARD OF NURSING
TX
Enumeration date
06/13/2019
Last updated
04/07/2020
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