Individual
PHYLLIS A WAKELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1500 COOPER ST, FORT WORTH, TX 76104-2710
(682) 885-7960
(682) 885-1327
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
514228
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062625101
—
TX
05
—
062625102
—
TX
05
—
062625103
—
TX
05
—
150220508
—
TX
05
—
150220509
—
TX
Enumeration date
06/22/2007
Last updated
08/31/2016
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