Provider Demographics
NPI:1720405384
Name:MODERN DAY WELLNESS
Entity Type:Organization
Organization Name:MODERN DAY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACYE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BYARS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-475-1139
Mailing Address - Street 1:1421 HURSTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3947
Mailing Address - Country:US
Mailing Address - Phone:817-475-1139
Mailing Address - Fax:
Practice Address - Street 1:1421 HURSTVIEW DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3947
Practice Address - Country:US
Practice Address - Phone:817-475-1139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509900261QB0400X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing