Provider Demographics
NPI:1366248890
Name:MCINTYRE, LANDRIA NICOLE (WHNP)
Entity type:Individual
Prefix:MRS
First Name:LANDRIA
Middle Name:NICOLE
Last Name:MCINTYRE
Suffix:
Gender:
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:610 DOVE CREEK PARK
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-1790
Mailing Address - Country:US
Mailing Address - Phone:901-598-3918
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGHWAY 287 N STE 103
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2874
Practice Address - Country:US
Practice Address - Phone:817-473-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1142324363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health