Organization
MYSTI BLU LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRIA BERNESTINE FNP (OWNER)
(972) 522-9799
Entity
Organization
Contact information
Practice address
2459 E. HEBRON PARKWAY, #130, CARROLLTON, TX 75010
(972) 522-9799
(469) 546-9723
Mailing address
3333 PRESTON ROAD, #300, FRISCO, TX 75034
(972) 522-9799
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
251F00000X
Home Infusion Agency
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
06/14/2023
Last updated
03/17/2025
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