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General NPI Number Information
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NPI Number | 1518652916
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Entity Type | Organization
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Legal Business Name | SYNERGY LIFESTYLE MEDICINE
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 4701 WEST FWY STE 500
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City | FORT WORTH
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State | TX
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Zip | 76107-5462
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Country | US
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Telephone | 682-465-1109
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Fax |
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Provider Business Mailing Address
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Address Line | 9220 SHOVELER TRL
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City | FORT WORTH
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State | TX
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Zip | 76118-7793
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Country | US
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Telephone | 682-465-1109
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. YVETTE BROOKS
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Credential | FNP-C
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Telephone | 682-465-1109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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