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General NPI Number Information
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NPI Number | 1831808427
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Entity Type | Organization
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Legal Business Name | FAMILY AFFAIR MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 3729 SHADY HOLLOW LN
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City | DALLAS
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State | TX
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Zip | 75233-3707
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Country | US
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Telephone | 832-454-9453
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 763552
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City | DALLAS
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State | TX
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Zip | 75376-3552
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Country | US
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Telephone | 832-454-9453
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | NICOLE CROWDER
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Credential | NP
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Telephone | 832-454-9453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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