Dedmon, Connie E

Dedmon, Connie E is an individual health care provider with primary practice located at 4405 River Oaks Blvd , Fort Worth TX 76114-2326. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Dedmon, Connie E can be contacted via phone (817) 624-1770.

Contact Information

Primary practice address
4405 River Oaks Blvd Fort Worth TX 76114-2326
Phone: (817) 624-1770
Fax: (817) 625-1287
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 230593 Texas

Profile Details

NPI number 1467437954
LBN Legal business name Dedmon, Connie E
Credentials Pediatric Nurse Practitioner (PNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 7th, 2005
Last updated Apr 3rd, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467437954 NPPES
Other 1750369203 GROUP NPI
MEDICAID 184937401 GROUP NPI
MEDICAID 184937403 GROUP NPI

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