Healthcare Provider Details

I. General information

NPI: 1891499497
Provider Name (Legal Business Name): VITALITY WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8707 SPRING CYPRESS RD STE E
SPRING TX
77379-3331
US

IV. Provider business mailing address

8707 SPRING CYPRESS RD STE E
SPRING TX
77379-3331
US

V. Phone/Fax

Practice location:
  • Phone: 832-562-3390
  • Fax: 832-562-3391
Mailing address:
  • Phone: 832-562-3390
  • Fax: 832-562-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLE CROSBY
Title or Position: VICE PRESIDENT
Credential: NP
Phone: 832-562-3390