Healthcare Provider Details

I. General information

NPI: 1285087775
Provider Name (Legal Business Name): HEALTH 2 GO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 BRIDGESTONE DR
FORT WORTH TX
76123-8006
US

IV. Provider business mailing address

4229 BRIDGESTONE DR
FORT WORTH TX
76123-8006
US

V. Phone/Fax

Practice location:
  • Phone: 901-830-7631
  • Fax:
Mailing address:
  • Phone: 901-830-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberAP117318
License Number StateTX

VIII. Authorized Official

Name: KIMBERLY MICHELLE WRIGHT
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP
Phone: 901-830-7631