Provider Demographics
NPI:1376901561
Name:KELMED HEALTH & WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:KELMED HEALTH & WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:682-227-5035
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:ITALY
Mailing Address - State:TX
Mailing Address - Zip Code:76651-0304
Mailing Address - Country:US
Mailing Address - Phone:972-393-0909
Mailing Address - Fax:817-635-8446
Practice Address - Street 1:204 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ITALY
Practice Address - State:TX
Practice Address - Zip Code:76651-3517
Practice Address - Country:US
Practice Address - Phone:972-393-0909
Practice Address - Fax:817-635-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty