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General NPI Number Information
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NPI Number | 1073022653
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Entity Type | Organization
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Legal Business Name | WALKER CONCIERGE HEALTH AND WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 661 E MAIN ST # 200175
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-3340
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Country | US
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Telephone | 469-364-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 661 E MAIN ST # 200175
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-3340
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Country | US
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Telephone | 469-364-1300
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Fax |
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Authorized Official
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Title or Position | ADULT GERO NURSE PRACTITIONER
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Name | KIZZY PRICE
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Credential | NP
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Telephone | 469-364-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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