=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225707342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESOTO HEALTHCARE CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2021
-----------------------------------------------------
Last Update Date | 02/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 860 HEBRON PKWY STE 704
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75057-5145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-777-2703
-----------------------------------------------------
Fax | 817-865-1530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1221 W AIRPORT FWY STE 209
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75062-6209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-567-9974
-----------------------------------------------------
Fax | 817-865-1530
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NAUREEN SALIM
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 469-567-9974
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------