Provider Demographics
NPI:1275186876
Name:WILCHER, KELLEY DAWN (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:DAWN
Last Name:WILCHER
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 COUNTY ROAD 3791
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:TX
Mailing Address - Zip Code:76073-4922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6049 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4815
Practice Address - Country:US
Practice Address - Phone:817-346-3313
Practice Address - Fax:817-346-3491
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily