Provider Demographics
NPI:1588389779
Name:VITALITY MEDICAL PLLC
Entity type:Organization
Organization Name:VITALITY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-389-4180
Mailing Address - Street 1:215 WESTSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3869
Mailing Address - Country:US
Mailing Address - Phone:940-273-5700
Mailing Address - Fax:940-273-5699
Practice Address - Street 1:215 WESTSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3869
Practice Address - Country:US
Practice Address - Phone:940-273-5700
Practice Address - Fax:940-273-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty