Provider Demographics
NPI:1477200657
Name:AMOUR FAMILY CLINIC, PLLC
Entity Type:Organization
Organization Name:AMOUR FAMILY CLINIC, PLLC
Other - Org Name:AMOUR FAMILY HEALTH & WELLNESS CLINIC, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYZETE
Authorized Official - Middle Name:AKWI
Authorized Official - Last Name:TALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:210-290-9740
Mailing Address - Street 1:5515 E EVANS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2025
Mailing Address - Country:US
Mailing Address - Phone:210-290-9740
Mailing Address - Fax:210-291-9741
Practice Address - Street 1:5515 E EVANS RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-2025
Practice Address - Country:US
Practice Address - Phone:210-290-9740
Practice Address - Fax:210-291-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty