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General NPI Number Information
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NPI Number | 1184501959
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Entity Type | Organization
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Legal Business Name | MIMETIC WELLNESS
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 6621 FM 1960 RD E STE 144
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City | HUMBLE
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State | TX
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Zip | 77346-2711
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Country | US
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Telephone | 346-819-9566
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Fax |
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Provider Business Mailing Address
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Address Line | 13531 WILL CLAYTON PKWY STE 300 PMB #164
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City | HUMBLE
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State | TX
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Zip | 77346-4850
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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 | NURSE PRACTITIONER/OWNER
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Name | ELIZABETH WRIGHT
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Credential | NP
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Telephone | 346-819-9566
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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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