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General NPI Number Information
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NPI Number | 1528330792
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Entity Type | Organization
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Legal Business Name | MEDI- ELITE, PC
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 11/24/2024
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Provider Practice Location Address
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Address Line | 2721 CENTRAL DR
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City | BEDFORD
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State | TX
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Zip | 76021-4810
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Country | US
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Telephone | 682-703-8881
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Fax | 706-203-3259
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Provider Business Mailing Address
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Address Line | 4621 S COOPER ST STE 131-717
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City | ARLINGTON
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State | TX
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Zip | 76017-5866
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Country | US
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Telephone | 214-277-2243
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Fax | 214-231-2926
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Authorized Official
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Title or Position | CEO
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Name | DR. MAHALIA L JACKSON-BUTLER
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Credential | DNP, APRN
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Telephone | 214-277-2243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AP117597
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | AP117597
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP117597
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP117597
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number | AP117597
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP117597
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License Number State | TX
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Taxonomy #7
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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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