Healthcare Provider Details

I. General information

NPI: 1750364998
Provider Name (Legal Business Name): ATASCOSA HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W OAKLAWN RD
PLEASANTON TX
78064-4033
US

IV. Provider business mailing address

310 W OAKLAWN RD
PLEASANTON TX
78064-4033
US

V. Phone/Fax

Practice location:
  • Phone: 830-569-2527
  • Fax: 830-569-8574
Mailing address:
  • Phone: 830-569-8940
  • Fax: 830-224-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateTX

VIII. Authorized Official

Name: LETICIA LYNN TACKITT
Title or Position: CREDENTIALING
Credential:
Phone: 830-569-8940