Healthcare Provider Details

I. General information

NPI: 1174430219
Provider Name (Legal Business Name): WELLNESS WINGS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 FM 2001 NO. 15801
BUDA TX
78610
US

IV. Provider business mailing address

1910 PACIFIC AVE STE 2000
DALLAS TX
75201-4540
US

V. Phone/Fax

Practice location:
  • Phone: 215-774-3527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACQUILINE MEDINA
Title or Position: CEO
Credential:
Phone: 215-774-3527