Individual
CARLY WITULSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1500 COOPER ST, FORT WORTH, TX 76104-2710
(682) 885-4007
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-6483
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
DT80647
TX
363LF0000X
Family Nurse Practitioner
Primary
1007578
TX
363LF0000X
Family Nurse Practitioner
845070
TX
Other
Enumeration date
04/17/2008
Last updated
04/06/2021
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