Provider Demographics
NPI:1033977145
Name:KNEISEL, DEVON
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:KNEISEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 TWIN MILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-5121
Mailing Address - Country:US
Mailing Address - Phone:817-718-1909
Mailing Address - Fax:
Practice Address - Street 1:6100 HARRIS PKWY STE 340
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4133
Practice Address - Country:US
Practice Address - Phone:817-646-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017794363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner