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General NPI Number Information
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NPI Number | 1437844461
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Entity Type | Organization
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Legal Business Name | MLTD ENTERPRISES LLC
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 1001 TRAVIS RANCH BLVD STE 1
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City | FORNEY
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State | TX
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Zip | 75126
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Country | US
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Telephone | 469-910-1842
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Fax |
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Provider Business Mailing Address
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Address Line | 1009 E INTERSTATE 30 STE 1074
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City | ROCKWALL
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State | TX
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Zip | 75087-4826
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Country | US
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Telephone | 940-206-5207
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MICAH DUKE
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Credential | APRN
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Telephone | 940-206-5207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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