Provider Demographics
NPI:1639476286
Name:TEXAS WELLNESS HEALTH CLINIC
Entity Type:Organization
Organization Name:TEXAS WELLNESS HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATRONICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-256-1752
Mailing Address - Street 1:40 FM 1960 W
Mailing Address - Street 2:STE. #194
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3530
Mailing Address - Country:US
Mailing Address - Phone:281-443-8226
Mailing Address - Fax:281-443-8157
Practice Address - Street 1:324 FM 1960 E
Practice Address - Street 2:STE. #101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1886
Practice Address - Country:US
Practice Address - Phone:281-443-8226
Practice Address - Fax:281-443-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6640630001Medicare NSC