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General NPI Number Information
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NPI Number | 1003069279
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Entity Type | Organization
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Legal Business Name | CLINIC FOR FAMILY WELLNESS PLLC
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Dates
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Enumeration Date | 10/31/2008
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1645 N 18TH ST
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City | MEMPHIS
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State | TX
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Zip | 79245-2059
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Country | US
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Telephone | 806-259-1058
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Fax | 806-259-1060
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Provider Business Mailing Address
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Address Line | 1645 N 18TH ST
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City | MEMPHIS
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State | TX
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Zip | 79245-2059
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Country | US
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Telephone | 806-259-1058
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Fax | 806-259-1060
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Authorized Official
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Title or Position | OWNER
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Name | MS. CAROLE D WARD
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Credential | FNP-C
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Telephone | 806-259-1058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 231272
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License Number State | TX
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