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Organization
CUSTOMMADEIMAGEHEALTH AND WELLNESS
Active
Organization
CUSTOMMADEIMAGEHEALTH AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA WILLIAMS (NURSE PRACTITIONER)
(214) 945-3702
Entity
Organization
Contact information
Practice address
825 WATTERS CREEK BLVD STE 250, ALLEN, TX 75013-3770
(214) 945-3702
Mailing address
1972 SUNNY SIDE DR, LITTLE ELM, TX 75068-7803
(214) 797-8767
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
—
NULL
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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