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General NPI Number Information
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NPI Number | 1760119440
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Entity Type | Organization
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Legal Business Name | TRINITY SALEM FAMILY HEALTH CLINIC PLLC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 1007 LEGACY RANCH RD STE 102
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City | WAXAHACHIE
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State | TX
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Zip | 75165-1294
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Country | US
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Telephone | 336-341-9295
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 LEGACY RANCH RD STE 102
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City | WAXAHACHIE
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State | TX
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Zip | 75165-1294
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Country | US
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Telephone | 972-666-8111
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Fax |
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Authorized Official
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Title or Position | OWNER., AUTHORIZED OFFICIAL
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Name | MRS. YAMINAH MATTHEWS
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Credential | APRN, FNP-BC
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Telephone | 972-666-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NULL
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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 | NULL
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