MEDICARE: PRAISE WELLNESS AND TELEHEALTH 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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1497603195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAISE WELLNESS AND TELEHEALTH CLINIC LLC

Provider Business Mailing Address
First Line	:	6913 N 40TH ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-5400
Country	:	US
Telephone Number	:	323-412-9966
Fax Number	:	323-412-9966

Provider Business Practice Location Address
First Line	:	6913 N 40TH ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-5400
Country	:	US
Telephone Number	:	323-412-9966
Fax Number	:	323-412-9966

Authorized Official
Title or Position	:	CEO
Name	:	LISA BLUM
Credential	:
Telephone Number	:	323-412-9966

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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