Provider Demographics
NPI:1265836704
Name:FUNCTIONAL HEALTH AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:FUNCTIONAL HEALTH AND WELLNESS, PLLC
Other - Org Name:INNOVATIVE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN, APRN
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEED
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:940-736-0627
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-0837
Mailing Address - Country:US
Mailing Address - Phone:940-736-0627
Mailing Address - Fax:903-487-2306
Practice Address - Street 1:2616 N LOY LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2535
Practice Address - Country:US
Practice Address - Phone:940-736-0627
Practice Address - Fax:903-487-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX728437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212697101Medicaid
TX8L22838Medicare PIN