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General NPI Number Information
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NPI Number | 1174092092
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Entity Type | Organization
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Legal Business Name | ATLAS VISITING PROVIDERS LLC
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 09/28/2024
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Provider Practice Location Address
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Address Line | 1701 W NORTHWEST HWY STE 240
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City | GRAPEVINE
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State | TX
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Zip | 76051-8107
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Country | US
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Telephone | 214-385-2808
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Fax | 214-382-0881
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Provider Business Mailing Address
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Address Line | 1701 W NORTHWEST HWY STE 240
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City | GRAPEVINE
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State | TX
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Zip | 76051-8107
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Country | US
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Telephone | 214-385-2808
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Fax | 214-382-0881
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Authorized Official
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Title or Position | OWNING MEMBER
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Name | MR. KAMALDEEN ISIAKA
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Credential | FNP-BC
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Telephone | 214-358-2808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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