=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588537278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURELY PEDIATRIC WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2025
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10670 N CENTRAL EXPY STE 110
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-250-3858
-----------------------------------------------------
Fax | 866-728-9963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10670 N CENTRAL EXPY STE 110
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-250-3858
-----------------------------------------------------
Fax | 866-728-9963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PEDIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | BROOKE ASHTON BARR
-----------------------------------------------------
Credential | DNP, APRN, CPNP-PC
-----------------------------------------------------
Telephone | 903-880-7707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------