Provider Demographics
NPI:1467132498
Name:INSPIRED SKIN WELLNESS, LLC.
Entity Type:Organization
Organization Name:INSPIRED SKIN WELLNESS, LLC.
Other - Org Name:INSPIRED HEALTH COMMUNITY CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-835-1867
Mailing Address - Street 1:929 RANCHO HERMOSO
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-0015
Mailing Address - Country:US
Mailing Address - Phone:972-835-1867
Mailing Address - Fax:
Practice Address - Street 1:7125 NEW SANGER AVE STE 502
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4054
Practice Address - Country:US
Practice Address - Phone:972-835-1867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty