# CENTER CARE CLINIC PLLC.

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

## Provider details

- **NPI number:** 1972391886
- **Authorized official:** CHAQUARRA LASTAYSHA MITCHELL FNP-BC (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (903) 787-2219

## Contact information

- **Practice address:** 1738 S JACKSON ST, JACKSONVILLE, TX 75766-5831
- **Practice address phone:** (903) 787-2219
- **Mailing address:** 1738 S JACKSON ST, JACKSONVILLE, TX 75766-5831
- **Mailing address phone:** (903) 787-2219

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/29/2025
- **Last updated:** 04/29/2025