Provider Demographics
NPI:1356117097
Name:WELLNESS AND WOUND GROUP A PROFESSIONAL LIMITED LIABILITY CORPORATION
Entity type:Organization
Organization Name:WELLNESS AND WOUND GROUP A PROFESSIONAL LIMITED LIABILITY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKRAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-960-2909
Mailing Address - Street 1:2829 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5454 SURREY PATH STE 201
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9582
Practice Address - Country:US
Practice Address - Phone:469-200-0117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center