Provider Demographics
NPI:1821455999
Name:ZELVYTE, RENATA
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:ZELVYTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENATA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4124 YANCEY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8589
Mailing Address - Country:US
Mailing Address - Phone:817-602-2688
Mailing Address - Fax:
Practice Address - Street 1:101 E PARK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5483
Practice Address - Country:US
Practice Address - Phone:972-424-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129978363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health