Provider Demographics
NPI:1922835529
Name:WELLNESS INTEGRATIVE HEALTH LLC
Entity type:Organization
Organization Name:WELLNESS INTEGRATIVE HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUINTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONKWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-352-2259
Mailing Address - Street 1:5121 COLLIN MCKINNEY PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1524
Mailing Address - Country:US
Mailing Address - Phone:469-352-2259
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4298
Practice Address - Country:US
Practice Address - Phone:469-352-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty