Most Relevant Information
Provider Data
| NPI Number: | 1003045204 |
| Provider Name: | AMY MICHELLE MEDALIE NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0200X |
| Specialty: | Nurse Practitioner |
| License Number: | 6037 |
Most Important Dates
| Enumeration Date: | 07/08/2009 |
| Last Updated: | 04/07/2021 |
Provider Practice Location
4405 RIVER OAKS BLVD
FORT WORTH
TX
761142326
Practice Location Phone/Fax
| Phone: | 8176241770 |
| Fax: | 8176251287 |
Provider Mailing Location
PO BOX 733784
DALLAS
TX
753733784
Provider Mailing Phone/Fax
| Phone: | 6828851855 |
| Fax: |