Basic Information
| Provider Information | |||||||||
| NPI: | 1811401334 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCLUSIVELY GERIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2721 WINDING CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PROSPER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750789518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4695699393 | ||||||||
| FaxNumber: | 8662880212 | ||||||||
| Practice Location | |||||||||
| Address1: | 2721 WINDING CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PROSPER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750789518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4695699393 | ||||||||
| FaxNumber: | 8662880212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2017 | ||||||||
| LastUpdateDate: | 11/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | STIGLETS | ||||||||
| AuthorizedOfficialFirstName: | CARLEY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4695699393 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.