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General NPI Number Information
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NPI Number | 1255016812
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Entity Type | Organization
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Legal Business Name | TAILORED DRIPS
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 6801 MCCART AVE STE 109
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City | FORT WORTH
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State | TX
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Zip | 76133-6378
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Country | US
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Telephone | 214-305-6882
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 PRESTON RD #1340 STE 300
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City | FRISCO
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State | TX
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Zip | 75034
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Country | US
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Telephone | 214-305-6882
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KAFAYAT ORITOLA
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Credential | NP
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Telephone | 214-305-6882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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