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General NPI Number Information
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NPI Number | 1023532348
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Entity Type | Organization
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Legal Business Name | ELITE NP CLINIC PLLC
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 412 E PLEASANT RUN RD STE B
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City | DESOTO
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State | TX
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Zip | 75115-3936
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Country | US
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Telephone | 682-325-9617
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Fax |
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Provider Business Mailing Address
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Address Line | 412 E PLEASANT RUN RD STE B
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City | DESOTO
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State | TX
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Zip | 75115-3936
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA WASHINGTON
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Credential | FNP
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Telephone | 469-857-3101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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