| Mysti Blu Llc | |
|
2459 E. Hebron Parkway #130 Carrollton TX 75010 | |
| (972) 522-9799 | |
| (469) 546-9723 |
| Full Name | Mysti Blu Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2459 E. Hebron Parkway, Carrollton, Texas |
| Authorized Official Name and Position | Jerria Bernestine (OWNER) |
| Authorized Official Contact | 9725229799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mysti Blu Llc 3333 Preston Road #300 Frisco TX 75034 Ph: (972) 522-9799 | Mysti Blu Llc 2459 E. Hebron Parkway #130 Carrollton TX 75010 Ph: (972) 522-9799 |
| NPI Number | 1609550219 |
|---|---|
| Provider Enumeration Date | 06/14/2023 |
| Last Update Date | 01/08/2024 |
| Medicare PECOS PAC ID | 5799137972 |
|---|---|
| Medicare Enrollment ID | O20240124000185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609550219 | NPI | - | NPPES |
| Provider Name | Jerria M Bernestine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578024931 PECOS PAC ID: 3274966692 Enrollment ID: I20191125002534 |
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