Provider Demographics
NPI:1851879761
Name:WALL, LORETTA (DNP)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:
Last Name:WALL
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0159
Mailing Address - Country:US
Mailing Address - Phone:817-247-0034
Mailing Address - Fax:469-942-9483
Practice Address - Street 1:8350 N CENTRAL EXPY STE 1900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1604
Practice Address - Country:US
Practice Address - Phone:469-942-9483
Practice Address - Fax:469-930-2597
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily