MEDICARE: PREMIER WELLNESS CLINICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1891349262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER WELLNESS CLINICS PLLC

Provider Business Mailing Address
First Line	:	2601 LITTLE ELM PKWY STE 1204
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-1921
Country	:	US
Telephone Number	:	972-292-0300
Fax Number	:	973-292-0301

Provider Business Practice Location Address
First Line	:	2601 LITTLE ELM PKWY STE 1204
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-1921
Country	:	US
Telephone Number	:	972-292-0300
Fax Number	:	973-292-0301

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	KHALIDA YASMIN
Credential	:	MD
Telephone Number	:	973-693-3677

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/17/2023

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