Provider Demographics
NPI:1295105591
Name:RELIABLE FAMILY WELLNESS, P.L.L.C.
Entity type:Organization
Organization Name:RELIABLE FAMILY WELLNESS, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:LOCKE, II
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:409-882-4705
Mailing Address - Street 1:3838 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-1812
Mailing Address - Country:US
Mailing Address - Phone:409-882-4705
Mailing Address - Fax:409-886-5305
Practice Address - Street 1:3838 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-1812
Practice Address - Country:US
Practice Address - Phone:409-882-4705
Practice Address - Fax:409-886-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty