Individual
MS. LINDA K BOUGHTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 921-3431
Mailing address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 921-3431
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
571139
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044387103
—
TX
Enumeration date
06/23/2006
Last updated
10/30/2012
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