Provider Demographics
NPI:1508618141
Name:PREMIER LIFE CARE LLC
Entity type:Organization
Organization Name:PREMIER LIFE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC, PMHNP-BC
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:BUKUNMI
Authorized Official - Last Name:FREMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-915-4211
Mailing Address - Street 1:2101 N MIDLAND DR STE 14B
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5599
Mailing Address - Country:US
Mailing Address - Phone:432-360-0046
Mailing Address - Fax:318-225-9274
Practice Address - Street 1:2101 N MIDLAND DR STE 14B
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5599
Practice Address - Country:US
Practice Address - Phone:347-331-4643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty