Basic Information
| Provider Information | |||||||||
| NPI: | 1558658286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EKLUND | ||||||||
| FirstName: | BRITNI | ||||||||
| MiddleName: | RENE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848476 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542024655 | ||||||||
| FaxNumber: | 2542024697 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 HILLCREST MEDICAL BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767128949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542026100 | ||||||||
| FaxNumber: | 2542026195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2011 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 72193 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | Q9602 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.