Provider Demographics
NPI:1689447856
Name:REYES, PAULETTE ARELY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:ARELY
Last Name:REYES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:ARELY
Other - Last Name:DOZAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1217 NIGHTHAWK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-6988
Mailing Address - Country:US
Mailing Address - Phone:915-422-1926
Mailing Address - Fax:
Practice Address - Street 1:6049 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4815
Practice Address - Country:US
Practice Address - Phone:817-346-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty