Provider Demographics
NPI:1689888398
Name:INNES, DENISE RENEE (FNP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:RENEE
Last Name:INNES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4009
Mailing Address - Country:US
Mailing Address - Phone:817-912-8000
Mailing Address - Fax:
Practice Address - Street 1:1650 W MAGNOLIA AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4009
Practice Address - Country:US
Practice Address - Phone:817-912-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX674692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1954364-03Medicaid
TX313904YMNTMedicare PIN