Provider Demographics
NPI:1154773240
Name:EXCLUSIVE WELLNESS & AESTHETICS, PLLC
Entity type:Organization
Organization Name:EXCLUSIVE WELLNESS & AESTHETICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:713-489-5784
Mailing Address - Street 1:11601 SHADOW CREEK PKWY
Mailing Address - Street 2:#111-555
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7283
Mailing Address - Country:US
Mailing Address - Phone:713-489-5784
Mailing Address - Fax:
Practice Address - Street 1:11200 BROADWAY ST
Practice Address - Street 2:SUITE 2743
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9785
Practice Address - Country:US
Practice Address - Phone:713-489-5784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty