# XTRA CARE CLINIC LLC

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

## Provider details

- **NPI number:** 1699440214
- **Authorized official:** EVELYNE IMAH (OWNER)
- **Authorized official phone:** (972) 365-0084

## Contact information

- **Practice address:** 10605 BOOMER CIR STE 105, DALLAS, TX 75238-5392
- **Practice address phone:** (972) 365-0084
- **Practice address fax:** (214) 221-7199
- **Mailing address:** 5700 SAINT THOMAS DR, PLANO, TX 75094-4620
- **Mailing address phone:** (972) 365-0084
- **Mailing address fax:** (214) 221-7199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/16/2021
- **Last updated:** 01/18/2022