# R2 WELL PRACTICE MANAGEMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235643149
- **Authorized official:** JOHNETTE VAN EEDEN (CEO)
- **Authorized official phone:** (817) 571-6505

## Contact information

- **Practice address:** 451 WESTPARK WAY STE 5, EULESS, TX 76040-3703
- **Practice address phone:** (817) 571-6505
- **Mailing address:** 451 WESTPARK WAY STE 5, EULESS, TX 76040-3703
- **Mailing address phone:** (817) 571-6505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0901X | Public Health & General Preventive Medicine Physician | G0723 | TX | Yes |

## Other

- **Enumeration date:** 11/30/2017
- **Last updated:** 11/30/2017