Organization
MYSTI BLU MANAGEMENT GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRIA BERNESTINE FNP-C (OWNER)
(310) 756-4829
Entity
Organization
Contact information
Practice address
2459 E HEBRON PKWY STE 130, CARROLLTON, TX 75010-4477
(972) 522-9799
(469) 546-9723
Mailing address
2459 E HEBRON PKWY STE 130, CARROLLTON, TX 75010-4477
(972) 522-9799
(469) 546-9723
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
251F00000X
Home Infusion Agency
Primary
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
11/30/2024
Last updated
11/30/2024
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