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General NPI Number Information
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NPI Number | 1306662010
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Entity Type | Organization
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Legal Business Name | IMPERIALHEALTH CLINIC PLLC
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 1626 W HIGHWAY 287 BUSINESS STE 104
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City | WAXAHACHIE
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State | TX
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Zip | 75165-4728
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Country | US
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Telephone | 469-414-2615
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Fax | 469-242-9743
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Provider Business Mailing Address
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Address Line | 1626 W HIGHWAY 287 BUSINESS STE 104
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City | WAXAHACHIE
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State | TX
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Zip | 75165-4728
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Country | US
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Telephone | 469-414-2615
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Fax | 469-242-9743
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE OMOTAYO
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Credential | DNP
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Telephone | 469-414-2615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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