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General NPI Number Information
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NPI Number | 1215689799
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Entity Type | Organization
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Legal Business Name | DRAGONFLY TELEHEALTH, INC.
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 160 SEPTEMBER DR
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City | STREETMAN
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State | TX
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Zip | 75859-3261
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Country | US
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Telephone | 931-628-9210
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Fax |
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Provider Business Mailing Address
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Address Line | 160 SEPTEMBER DR
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City | STREETMAN
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State | TX
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Zip | 75859-3261
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Country | US
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Telephone | 931-628-9210
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KIMBERLY MODENA TATUM
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Credential | FNP-C
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Telephone | 931-628-9210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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