Twelve52 Wellness Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

TWELVE52 WELLNESS CLINIC

Practice address

2010 Gilmer Rd Ste 103a
Longview, TX 75604-2545

Phone

(903) 347-5483

NPI assigned

May 31, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tameka Royal, APRN

Title

Nurse Practitioner

Phone

(903) 399-4521

Specialties & licenses 2

Addresses

Other names 1

• Twelve52 Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1386210441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9711",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756089711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 GILMER RD STE 103A",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756042545",
            "telephone_number": "903-347-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWELVE52 WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-31",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "ROYAL",
        "authorized_official_first_name": "TAMEKA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "903-399-4521",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Twelve52 Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Twelve52 Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aaron Clark Turner
• Rejade Turner
• Shauna Turner
• Tiffany John'Nie Turner, MD
• Marcus Dale Turney, RN, FNP-C
• Tiffany Tyeskie, FNP-C
• Shanacia Tyiska
• U First Physical Therapy and Wellness PLLC
• Adelaido Parilla Ubalde Jr., PT
• Jeanne Marie Santos Ubalde, PT, CLT

• Primary Care Clinic/Center in Longview, TX
• Providers in Longview, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.