Organization
OLD CORNER WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY JAMES NIEMEYER (OWNER)
(254) 826-5122
Entity
Organization
Contact information
Practice address
200 N MAIN ST, WEST, TX 76691-1207
(254) 826-5122
Mailing address
200 N MAIN ST, WEST, TX 76691-1207
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/23/2023
Last updated
06/04/2024
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