Provider Demographics
NPI:1083424295
Name:NORTH TEXAS NUTRITION & WELLNESS
Entity type:Organization
Organization Name:NORTH TEXAS NUTRITION & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KACYE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:940-736-5317
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:VALLEY VIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76272-0308
Mailing Address - Country:US
Mailing Address - Phone:940-736-5317
Mailing Address - Fax:
Practice Address - Street 1:903 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4235
Practice Address - Country:US
Practice Address - Phone:940-336-4584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KACYE M VANN NURSE PRACTITIONER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-09
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1689279374Medicaid
1689279374OtherCOMMERCIAL INSURANCE