Provider Demographics
NPI:1104307990
Name:KAYSSI, FARIS (FNP)
Entity type:Individual
Prefix:MR
First Name:FARIS
Middle Name:
Last Name:KAYSSI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:FARIS
Other - Middle Name:
Other - Last Name:AL-KAYSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4500 MERCANTILE PLAZA DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4214
Mailing Address - Country:US
Mailing Address - Phone:469-327-7694
Mailing Address - Fax:
Practice Address - Street 1:4500 MERCANTILE PLAZA DR STE 204
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4214
Practice Address - Country:US
Practice Address - Phone:469-327-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP138593OtherTEXAS BOARD OF NURSING