MEDICARE: WHOLESOME CLINIC, LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1285329128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLESOME CLINIC, LLC

Provider Business Mailing Address
First Line	:	7978 PRESTON RD STE 804
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-5607
Country	:	US
Telephone Number	:	972-905-9435
Fax Number	:

Provider Business Practice Location Address
First Line	:	7978 PRESTON RD STE 804
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-5607
Country	:	US
Telephone Number	:	972-905-9435
Fax Number	:	972-905-9489

Authorized Official
Title or Position	:	NP/DIRECTOR
Name	:	STEPHANIE UCHENNA
Credential	:	NP
Telephone Number	:	972-905-9534

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/13/2026

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