Healthcare Provider Details

I. General information

NPI: 1215781950
Provider Name (Legal Business Name): THERAWELL MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 05/05/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23414 BAKER HILL DR
RICHMOND TX
77469-2567
US

IV. Provider business mailing address

23414 BAKER HILL DR
RICHMOND TX
77469-2567
US

V. Phone/Fax

Practice location:
  • Phone: 346-613-0227
  • Fax:
Mailing address:
  • Phone: 346-613-0227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DORCAS AYANGA
Title or Position: OWNER
Credential: NP
Phone: 346-613-0227