Healthcare Provider Details

I. General information

NPI: 1750621454
Provider Name (Legal Business Name): NELSON FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HURST ST
CENTER TX
75935-3414
US

IV. Provider business mailing address

604 HURST ST
CENTER TX
75935-3414
US

V. Phone/Fax

Practice location:
  • Phone: 903-598-5633
  • Fax:
Mailing address:
  • Phone: 903-598-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number250589
License Number StateTX

VIII. Authorized Official

Name: MRS. SHARON NELSON
Title or Position: OWNER/PROVIDER
Credential: RN, FNP-C
Phone: 936-598-5633