Amy Michelle Medalie, NP
Nurse Practitioner, Pediatrics in Fort Worth, TX. Individual provider (NPI-1).
NPI number1003045204
StatusActive
Last updated in NPPESApr 7, 2021
Details
- NPI
- 1003045204
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Amy Michelle Medalie
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 8, 2009
- Certification date
- Apr 7, 2021
- Last updated
- Apr 7, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0200X | Nurse Practitioner, Pediatrics | 6037 | CO | Yes |
Other names
- Amy Michelle Medalie (Former Name)
Practice location
4405 River Oaks BlvdFort Worth, TX 76114-2326
Phone 817-624-1770 · Fax 817-625-1287
Mailing address
Po Box 733784Dallas, TX 75373-3784
Phone 682-885-1855
Other practice locations
255 Union Blvd Ste 120
Lakewood, CO 80228-1833
Lakewood, CO 80228-1833
Phone 303-936-7415
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 133 Pediatric Nurse Practitioner providers in Fort Worth · All 20,155 providers in Fort Worth
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