Provider Demographics
NPI:1336521731
Name:INVIGORATE MEN'S HEALTH & WELLNESS, PLLC
Entity Type:Organization
Organization Name:INVIGORATE MEN'S HEALTH & WELLNESS, PLLC
Other - Org Name:INVIGORATE: LOW-T - HEALTH - WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:NUNNELEY
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:940-386-9334
Mailing Address - Street 1:4001 CEDAR ELM LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3031
Mailing Address - Country:US
Mailing Address - Phone:940-386-9334
Mailing Address - Fax:940-386-9733
Practice Address - Street 1:4001 CEDAR ELM LN
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3031
Practice Address - Country:US
Practice Address - Phone:940-386-9334
Practice Address - Fax:940-386-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110354261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144490302Medicaid
TX144490304Medicaid
TX144490304Medicaid