Provider Demographics
NPI:1730168501
Name:ALTHAUS, BECKY WIGHTMAN (RN, PHD, CGC)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:WIGHTMAN
Last Name:ALTHAUS
Suffix:
Gender:F
Credentials:RN, PHD, CGC
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:WIGHTMAN
Other - Last Name:ALTHAUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, PHD, FNP-BC
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:750 8TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2500
Practice Address - Country:US
Practice Address - Phone:682-885-2170
Practice Address - Fax:817-335-8277
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270.1006170300000X
TX230870363LF0000X
TXAP121066363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No170300000XOther Service ProvidersGenetic Counselor, MS
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily