Provider Demographics
NPI:1023900768
Name:ETX INJECT COSMETICS & WELLNESS CRANDALL PLLC
Entity type:Organization
Organization Name:ETX INJECT COSMETICS & WELLNESS CRANDALL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-288-3485
Mailing Address - Street 1:121 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114-2901
Mailing Address - Country:US
Mailing Address - Phone:903-802-5167
Mailing Address - Fax:
Practice Address - Street 1:1829 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-4401
Practice Address - Country:US
Practice Address - Phone:903-288-3485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care