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General NPI Number Information
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NPI Number | 1154031458
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Entity Type | Organization
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Legal Business Name | PALLICARE HEALTH, PLLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 5803 STONERIDGE DR
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City | TEXARKANA
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State | TX
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Zip | 75503-1461
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Country | US
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Telephone | 972-632-9642
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Fax |
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Provider Business Mailing Address
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Address Line | 5803 STONERIDGE DR
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City | TEXARKANA
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State | TX
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Zip | 75503-1461
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Country | US
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Telephone | 972-632-9642
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN FLUHART
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Credential |
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Telephone | 972-632-9642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number |
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License Number State |
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