Organization · NPI-2
180 Health Clinic, PLLC
Nurse Practitioner, Primary Care · Fort Worth, TX
NPI number1841069309
StatusActive
Last updated in NPPESDec 26, 2023
Details
- NPI
- 1841069309
- Entity type
- Organization (NPI-2)
- Legal business name
- 180 Health Clinic, PLLC
- Organization subpart
- No
- Enumeration date
- Dec 26, 2023
- Certification date
- Jun 29, 2023
- Last updated
- Dec 26, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP2300X | Nurse Practitioner, Primary Care | – | – | Yes |
| 363L00000X | Nurse Practitioner | – | – | |
| 363LA2200X | Nurse Practitioner, Adult Health | – | – | |
| 363LG0600X | Nurse Practitioner, Gerontology | – | – |
Practice location
1801 Eastchase Pkwy Ste 123Fort Worth, TX 76120-4425
Phone 682-622-8990
Mailing address
Po Box 200172Arlington, TX 76006-0172
Phone 919-623-0408
Authorized official
April La Shonda Phillips
Owner/NP
9196230408
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