Provider Demographics
NPI:1588414494
Name:DEMITCHELL, ALICIA NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:NICOLE
Last Name:DEMITCHELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ALLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-5356
Mailing Address - Country:US
Mailing Address - Phone:616-690-8638
Mailing Address - Fax:
Practice Address - Street 1:3051 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2023
Practice Address - Country:US
Practice Address - Phone:817-468-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1130631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily