Basic Information
| Provider Information | |||||||||
| NPI: | 1942395900 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REACH | ||||||||
| FirstName: | GAYLA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 MAIN ST | ||||||||
| Address2: | STE C | ||||||||
| City: | LAKE DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750652878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403825230 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 WOODHAVEN BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761122376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174298300 | ||||||||
| FaxNumber: | 8174296167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP104113 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.