Provider Demographics
NPI:1508367616
Name:HEALTHY PROMISE FAMILY PRACTICE
Entity Type:Organization
Organization Name:HEALTHY PROMISE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:FERMENA
Authorized Official - Last Name:HEUSNER-BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-884-2904
Mailing Address - Street 1:PO BOX 61160
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1160
Mailing Address - Country:US
Mailing Address - Phone:361-884-2904
Mailing Address - Fax:361-884-1912
Practice Address - Street 1:5920 SARATOGA BLVD STE 470
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4108
Practice Address - Country:US
Practice Address - Phone:361-884-2904
Practice Address - Fax:361-884-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty