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305 W Woodard St Ste 201 Denison TX 75020-3136 | |
| (903) 265-8545 | |
| (903) 487-0600 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 305 W Woodard St Ste 201, Denison, Texas |
| Authorized Official Name and Position | Brittainy A Wagner (OWNER PROVIDER) |
| Authorized Official Contact | 9032674023 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1431 W Woodard St Denison TX 75020-3449 Ph: (903) 267-4023 | 305 W Woodard St Ste 201 Denison TX 75020-3136 Ph: (903) 265-8545 |
| NPI Number | 1275939001 |
|---|---|
| Provider Enumeration Date | 11/05/2014 |
| Last Update Date | 09/17/2024 |
| Certification Date | 09/17/2024 |
| Medicare PECOS PAC ID | 7416283775 |
|---|---|
| Medicare Enrollment ID | O20190724000985 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275939001 | NPI | - | NPPES |
| Provider Name | Laurie A Trotter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881935856 PECOS PAC ID: 8729225354 Enrollment ID: I20130518000099 |
| Provider Name | Caroline K Mose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720447584 PECOS PAC ID: 8022316645 Enrollment ID: I20160415000607 |
| Provider Name | Deborah Frempong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811423981 PECOS PAC ID: 0244504546 Enrollment ID: I20170926001571 |
| Provider Name | Tessie Eberhart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992322168 PECOS PAC ID: 6507284304 Enrollment ID: I20200918000145 |
| Provider Name | Risikat Idowu Lawal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902339096 PECOS PAC ID: 5698155851 Enrollment ID: I20220706000112 |
| Provider Name | Winell Jenetta Soures |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336433846 PECOS PAC ID: 1850767492 Enrollment ID: I20221021002051 |
| Provider Name | Melinda Richard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831557800 PECOS PAC ID: 9032555438 Enrollment ID: I20240307002849 |
| Provider Name | Courtney Brewer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851886899 PECOS PAC ID: 5597101469 Enrollment ID: I20240313004299 |
| Provider Name | Brittainy Wagner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023429750 PECOS PAC ID: 4385970649 Enrollment ID: I20240520001827 |
| Provider Name | Carla Sue Mcgehee |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1033572045 PECOS PAC ID: 7214471275 Enrollment ID: I20240701003263 |
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