Provider Demographics
NPI:1225117609
Name:BUESCHER, ALICIA (NP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BUESCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 HARRIS PKWY STE 1240
Mailing Address - Street 2:PEASE BUILDING
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4101
Mailing Address - Country:US
Mailing Address - Phone:817-346-0075
Mailing Address - Fax:817-346-0097
Practice Address - Street 1:6100 HARRIS PKWY STE 1240
Practice Address - Street 2:PEASE BUILDING
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4101
Practice Address - Country:US
Practice Address - Phone:817-346-0075
Practice Address - Fax:817-346-0097
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241020363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215156501Medicaid
TX145319302Medicaid
TXTXB108921Medicare PIN
TX86N176Medicare PIN
TX145319302Medicaid