Provider Demographics
NPI:1568982304
Name:WHOLISTIC HEALTHCARE SOLUTIONS: MIND, BODY & SPIRIT, PLLC
Entity Type:Organization
Organization Name:WHOLISTIC HEALTHCARE SOLUTIONS: MIND, BODY & SPIRIT, PLLC
Other - Org Name:PEDIADULTS (PEDIATRICS & ADULTS) AFTER HOURS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:972-896-9501
Mailing Address - Street 1:1350 NORTHWEST HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5844
Mailing Address - Country:US
Mailing Address - Phone:972-896-9501
Mailing Address - Fax:469-899-1275
Practice Address - Street 1:1350 NORTHWEST HWY STE 105
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5844
Practice Address - Country:US
Practice Address - Phone:972-896-9501
Practice Address - Fax:469-899-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty