| Evolve Wellness And Aesthetics Pllc | |
|
12650 N Beach St Ste 114-946 Fort Worth TX 76244-4256 | |
| (214) 843-0713 | |
| Not Available |
| Full Name | Evolve Wellness And Aesthetics Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12650 N Beach St Ste 114-946, Fort Worth, Texas |
| Authorized Official Name and Position | Shayla Sewell (OWNER) |
| Authorized Official Contact | 2148430713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolve Wellness And Aesthetics Pllc 12650 N Beach St Ste 114-946 Fort Worth TX 76244-4256 Ph: (214) 843-0713 | Evolve Wellness And Aesthetics Pllc 12650 N Beach St Ste 114-946 Fort Worth TX 76244-4256 Ph: (214) 843-0713 |
| NPI Number | 1942940812 |
|---|---|
| Provider Enumeration Date | 03/30/2022 |
| Last Update Date | 06/12/2024 |
| Medicare PECOS PAC ID | 1254704745 |
|---|---|
| Medicare Enrollment ID | O20230303000635 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942940812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Shayla Sewell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427633635 PECOS PAC ID: 6103200779 Enrollment ID: I20220831000614 |
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