MEDICARE: TRUSTED CARE TELEHEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1194485235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUSTED CARE TELEHEALTH PLLC

Provider Business Mailing Address
First Line	:	9210 WATERS LN
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75089-4808
Country	:	US
Telephone Number	:	817-881-2329
Fax Number	:

Provider Business Practice Location Address
First Line	:	7406 W STATE HIGHWAY 66
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-4166
Country	:	US
Telephone Number	:	817-881-2329
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	KIMBERLY DAVONG
Credential	:
Telephone Number	:	817-881-2329

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	04/01/2022

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