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General NPI Number Information
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NPI Number | 1265836704
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL HEALTH AND WELLNESS, PLLC
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 2616 N LOY LAKE RD SUITE A
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City | SHERMAN
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State | TX
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Zip | 75090-2535
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Country | US
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Telephone | 940-736-0627
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Fax | 903-487-2306
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Provider Business Mailing Address
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Address Line | PO BOX 837
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City | HOWE
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State | TX
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Zip | 75459-0837
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Country | US
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Telephone | 940-736-0627
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Fax | 903-487-2306
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Authorized Official
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Title or Position | RN, APRN
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Name | KAREN S STEED
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Credential | RN
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Telephone | 940-736-0627
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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 | 728437
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License Number State | TX
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