=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427370790
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTHWATCH, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2010
-----------------------------------------------------
Last Update Date | 02/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4041 W WHEATLAND RD ST 116
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75237-4063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-566-2344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4041 W WHEATLAND RD ST 116
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75237-4063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-566-2344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | ARAMIDE DORCAS ALAYANDE
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 214-566-2344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 673937
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------