| NPI | 1295534907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENELLE DUGAN Family Nurse Practitioner 682-746-8082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261Q00000X Clinic/Center | |
| 335G00000X Medical Foods Supplier | |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2025-09-30 |