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Organization

IVYY, P.C

Active
Organization subpart
No

Provider details

NPI number
Authorized official
VIDA RISTON CNM, FNP (CEO)
(409) 838-4472
Entity
Organization

Contact information

Practice address
2965 HARRISON ST STE 313, BEAUMONT, TX 77702-1113
(409) 838-4472
Mailing address
2965 HARRISON ST STE 313, BEAUMONT, TX 77702-1113
(409) 838-4472

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
540793
TX

Other

Enumeration date
10/26/2006
Last updated
05/20/2021
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