Provider Demographics
NPI:1558983197
Name:PRIORITY FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:PRIORITY FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRISTON
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:936-590-4708
Mailing Address - Street 1:PO BOX 1749
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-1749
Mailing Address - Country:US
Mailing Address - Phone:936-590-4708
Mailing Address - Fax:936-590-4815
Practice Address - Street 1:1743 SOUTHVIEW CIR
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-9324
Practice Address - Country:US
Practice Address - Phone:903-692-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-16
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty