Provider Demographics
NPI:1285063370
Name:FAMILY HEALTHCARE CLINIC, PLLC
Entity type:Organization
Organization Name:FAMILY HEALTHCARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:325-823-7575
Mailing Address - Street 1:123 SANTA ANNA AVE
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-7409
Mailing Address - Country:US
Mailing Address - Phone:325-823-7575
Mailing Address - Fax:325-455-7982
Practice Address - Street 1:123 SANTA ANNA AVE
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-7409
Practice Address - Country:US
Practice Address - Phone:325-625-9000
Practice Address - Fax:325-625-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
TX785855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty