Organization
IMPERIALHEALTH CLINIC PLLC
Active
Other names
IMPERIAL HEALTH PSYCHIATRY
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE OMOTAYO DNP (OWNER)
(469) 414-2615
Entity
Organization
Contact information
Practice address
1626 W HIGHWAY 287 BUSINESS STE 104, WAXAHACHIE, TX 75165-4728
(469) 414-2615
(469) 242-9743
Mailing address
1626 W HIGHWAY 287 BUSINESS STE 104, WAXAHACHIE, TX 75165-4728
(469) 414-2615
(469) 242-9743
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP135407
STATE LICENSE
TX
Enumeration date
11/26/2024
Last updated
07/04/2025
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