Provider Demographics
NPI:1891349262
Name:PREMIER WELLNESS CLINICS PLLC
Entity Type:Organization
Organization Name:PREMIER WELLNESS CLINICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHALIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YASMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-693-3677
Mailing Address - Street 1:2601 LITTLE ELM PKWY STE 1204
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1921
Mailing Address - Country:US
Mailing Address - Phone:972-292-0300
Mailing Address - Fax:973-292-0301
Practice Address - Street 1:2601 LITTLE ELM PKWY STE 1204
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1921
Practice Address - Country:US
Practice Address - Phone:972-292-0300
Practice Address - Fax:973-292-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty