Provider Demographics
NPI:1093320996
Name:VITALITY CARE LLC
Entity Type:Organization
Organization Name:VITALITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-213-2717
Mailing Address - Street 1:3139 W HOLCOMBE BLVD # A29
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1533
Mailing Address - Country:US
Mailing Address - Phone:713-213-2717
Mailing Address - Fax:
Practice Address - Street 1:2646 S LOOP W STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2640
Practice Address - Country:US
Practice Address - Phone:832-342-6326
Practice Address - Fax:832-575-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty