Provider Demographics
NPI:1649998675
Name:WALTER J FAMILY AND WELLNESS CLINIC PLLC
Entity type:Organization
Organization Name:WALTER J FAMILY AND WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:N
Authorized Official - Last Name:ONYECHEFUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC
Authorized Official - Phone:281-788-8103
Mailing Address - Street 1:9115 FM 723 RD STE 500
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-9235
Mailing Address - Country:US
Mailing Address - Phone:832-400-2118
Mailing Address - Fax:832-400-2119
Practice Address - Street 1:3129 KINGSLEY DR STE 1630
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8510
Practice Address - Country:US
Practice Address - Phone:832-400-2118
Practice Address - Fax:832-400-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty