Organization
FORT PHYSICIANS & PROFESSIONALS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICE ANN KUCHINSKAS (PAYER RELATIONS)
(562) 544-7823
Entity
Organization
Contact information
Practice address
5833 OAK BEND TRAIL, FORT WORTH, TX 76132-3900
(817) 678-7428
(682) 707-5750
Mailing address
7140 OAKMONT BLVD., FORT WORTH, TX 76132-3900
(625) 447-8235
(949) 485-6212
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
04/13/2020
Last updated
04/13/2020
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