Supreme Wisdom Family Health Clinic Inc

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

682811 Issued in TX

Legal business name

SUPREME WISDOM FAMILY HEALTH CLINIC INC

Practice address

455 Gotland Dr
Grand Prairie, TX 75052-2570

Phone

(469) 831-3149

NPI assigned

Aug 26, 2011

Last updated

Sep 15, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Khaliliah Ali, FNP-C, APRN, BC

Title

President

Phone

(469) 835-3449

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1314316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1801176474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 GOTLAND DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750522570",
            "telephone_number": "469-831-3149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 GOTLAND DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750522570",
            "telephone_number": "469-831-3149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME WISDOM FAMILY HEALTH CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-26",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "KHALILIAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-835-3449",
        "authorized_official_credential": "FNP-C, APRN, BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "682811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; 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.