Organization
PURPLE HEARTS PRIMARY CARE SERVICES, PLLC
Active
Other names
Purple Hearts Primary Care Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RAVEN MODISETTE FNP-C,PMHNP-BC (CEO)
(817) 969-4651
Entity
Organization
Contact information
Practice address
688 W PIONEER PKWY STE 120, GRAND PRAIRIE, TX 75051-4861
(817) 969-4651
(214) 710-2188
Mailing address
3901 ARLINGTON HIGHLANDS BLVD STE 281, ARLINGTON, TX 76018-6036
(817) 969-4651
(214) 710-2188
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
AP137299
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
393575101
—
TX
Enumeration date
06/11/2018
Last updated
12/07/2020
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