=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750278271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALE WELLNESS GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2025
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 423 KELLER PKWY STE B
-----------------------------------------------------
City | KELLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76248-2322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-788-0340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 423 KELLER PKWY STE B
-----------------------------------------------------
City | KELLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76248-2322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-788-0340
-----------------------------------------------------
Fax | 817-612-3298
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | MRS. CHRISTINE ZEPEDA
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 682-788-0340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------