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General NPI Number Information
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NPI Number | 1457993297
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Entity Type | Organization
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Legal Business Name | TEXANS HEALTH & WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 4125 BROADWAY BLVD STE 120C
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City | GARLAND
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State | TX
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Zip | 75043-2500
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Country | US
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Telephone | 972-303-0861
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Fax | 972-303-0928
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Provider Business Mailing Address
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Address Line | 760 BELVEDERE PARK LN
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City | LUCAS
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State | TX
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Zip | 75002-8853
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Country | US
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Telephone | 972-303-0861
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Fax | 972-303-0928
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Authorized Official
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Title or Position | OWNER
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Name | JAYE C KRUBALLY
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Credential | FNP-BC
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Telephone | 972-303-0861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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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 | 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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