MEDICARE: HEAVENLY HANDS FAMILY MEDICAL CLINIC, 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1285275560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HANDS FAMILY MEDICAL CLINIC, PLLC

Provider Business Mailing Address
First Line	:	7602 GREAT TRINITY FOREST WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-6650
Country	:	US
Telephone Number	:	469-779-2000
Fax Number	:	877-441-1590

Provider Business Practice Location Address
First Line	:	7602 GREAT TRINITY FOREST WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-6650
Country	:	US
Telephone Number	:	469-779-2000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LAKESHIA GRIFFIN
Credential	:	NP
Telephone Number	:	469-779-2000

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	12/31/2025

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