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Organization
XTRA CARE CLINIC LLC
Active
Organization
XTRA CARE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYNE IMAH (OWNER)
(972) 365-0084
Entity
Organization
Contact information
Practice address
10605 BOOMER CIR STE 105, DALLAS, TX 75238-5392
(972) 365-0084
(214) 221-7199
Mailing address
5700 SAINT THOMAS DR, PLANO, TX 75094-4620
(972) 365-0084
(214) 221-7199
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/16/2021
Last updated
01/18/2022
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