Healthcare Provider Details

I. General information

NPI: 1083424295
Provider Name (Legal Business Name): NORTH TEXAS NUTRITION & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 E BROADWAY ST
GAINESVILLE TX
76240-4235
US

IV. Provider business mailing address

PO BOX 308
VALLEY VIEW TX
76272-0308
US

V. Phone/Fax

Practice location:
  • Phone: 940-336-4584
  • Fax:
Mailing address:
  • Phone: 940-736-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KACYE MICHELLE VANN
Title or Position: OWNER/PROVIDER
Credential: FNP-C
Phone: 940-736-5317