Healthcare Provider Details

I. General information

NPI: 1508071697
Provider Name (Legal Business Name): COMANCHE FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VALLEY FORGE ST
COMANCHE TX
76442-1813
US

IV. Provider business mailing address

105 VALLEY FORGE ST
COMANCHE TX
76442-1813
US

V. Phone/Fax

Practice location:
  • Phone: 325-356-7530
  • Fax: 325-356-5388
Mailing address:
  • Phone: 325-356-7530
  • Fax: 325-356-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number607586
License Number StateTX

VIII. Authorized Official

Name: MRS. RACHEL N HILLIARD
Title or Position: OWNER
Credential: FNP
Phone: 325-325-7530