Provider Demographics
NPI:1962985903
Name:DEWEESE, BOBBIE JO (RN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JO
Last Name:DEWEESE
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:MISS
Other - First Name:BOBBIE
Other - Middle Name:JO
Other - Last Name:CUTCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:279 W HIDDEN CREEK PKWY STE 1209
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6077
Mailing Address - Country:US
Mailing Address - Phone:817-629-2616
Mailing Address - Fax:817-662-6255
Practice Address - Street 1:279 W HIDDEN CREEK PKWY STE 1209
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-629-2616
Practice Address - Fax:817-662-6255
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138096363LP2300X, 363LF0000X
TX830038163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse