Healthcare Provider Details

I. General information

NPI: 1992579080
Provider Name (Legal Business Name): ALL FAMILY WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 INDUSTRIAL CT
ARLINGTON TX
76011-4726
US

IV. Provider business mailing address

1606 INDUSTRIAL CT
ARLINGTON TX
76011-4726
US

V. Phone/Fax

Practice location:
  • Phone: 682-248-3918
  • Fax: 682-248-3321
Mailing address:
  • Phone: 682-248-3918
  • Fax: 682-248-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KALETHIA BUSH
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 972-861-2013