Healthcare Provider Details

I. General information

NPI: 1568116291
Provider Name (Legal Business Name): ACCESS WELLNESS RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 WESTERN CENTER BLVD STE 312
FORT WORTH TX
76131-4302
US

IV. Provider business mailing address

2340 E TRINITY MILLS RD STE 250
CARROLLTON TX
75006-1946
US

V. Phone/Fax

Practice location:
  • Phone: 855-893-5637
  • Fax: 817-666-3873
Mailing address:
  • Phone: 855-893-5637
  • Fax: 817-666-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MILLER
Title or Position: DIRECTOR
Credential: MD
Phone: 210-793-1311