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General NPI Number Information
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NPI Number | 1154157329
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Entity Type | Organization
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Legal Business Name | SPARTA WELLNESS CLINIC PLLC
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 2990 STATE HIGHWAY 66
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City | CADDO MILLS
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State | TX
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Zip | 75135-6196
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Country | US
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Telephone | 972-533-8556
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Fax | 341-999-2031
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Provider Business Mailing Address
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Address Line | 2990 STATE HIGHWAY 66
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City | CADDO MILLS
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State | TX
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Zip | 75135-6196
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Country | US
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Telephone | 972-533-8556
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Fax | 341-999-2031
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Authorized Official
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Title or Position | PRESIDENT
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Name | NAOMI KAY KRAMER
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Credential | FNP-C
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Telephone | 972-533-8556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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