MEDICARE: VALLEY VIEW 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	363LF0000X	Family Nurse Practitioner		TX
2	207Q00000X	Family Medicine Physician		TX

General Provider Information

NPI Number	:	1427590264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY VIEW FAMILY MEDICAL CLINIC, PLLC

Provider Business Mailing Address
First Line	:	909 N FRONTAGE RD
Second Line	:
City	:	VALLEY VIEW
State	:	TX
Zip	:	76272-9227
Country	:	US
Telephone Number	:	940-726-5750
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 N FRONTAGE RD
Second Line	:
City	:	VALLEY VIEW
State	:	TX
Zip	:	76272-9227
Country	:	US
Telephone Number	:	940-726-5750
Fax Number	:

Authorized Official
Title or Position	:	FNP PART OWNER
Name	:	POLLY KLEMENT
Credential	:	FNP
Telephone Number	:	940-726-5750

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	11/10/2016

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