| Tyler Wellness Clinic | |
|
649 S Broadway Ave Ste 2 Tyler TX 75701-1677 | |
| (903) 747-8107 | |
| (903) 747-8113 |
| Full Name | Tyler Wellness Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 649 S Broadway Ave Ste 2, Tyler, Texas |
| Authorized Official Name and Position | Stacie Cameron (FAMILY NURSE PRACTITIONER/OWNER) |
| Authorized Official Contact | 9037478107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Wellness Clinic Po Box 7217 Tyler TX 75711-7217 Ph: () - | Tyler Wellness Clinic 649 S Broadway Ave Ste 2 Tyler TX 75701-1677 Ph: (903) 747-8107 |
| NPI Number | 1508572959 |
|---|---|
| Provider Enumeration Date | 01/30/2023 |
| Last Update Date | 12/06/2023 |
| Medicare PECOS PAC ID | 4183099583 |
|---|---|
| Medicare Enrollment ID | O20230418001153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508572959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Stacie Renee Cameron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336662907 PECOS PAC ID: 0345506127 Enrollment ID: I20171110001283 |
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