Provider Demographics
NPI:1104279058
Name:WHARRY PLATINUM FAMILY CARE CLINIC, PLLC
Entity type:Organization
Organization Name:WHARRY PLATINUM FAMILY CARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:432-770-8690
Mailing Address - Street 1:604 KENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5805
Mailing Address - Country:US
Mailing Address - Phone:432-770-8690
Mailing Address - Fax:
Practice Address - Street 1:604 KENT ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5805
Practice Address - Country:US
Practice Address - Phone:432-770-8690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05488363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty