NPI 1003632522

Mysti Blu Management Group, LLC

Organisation Home Infusion Agency Carrollton, TX

Practice location

Address: 2459 E Hebron Pkwy STE 130, Carrollton, TX 75010-4477
Phone: (972) 522-9799
Fax: (469) 546-9723

Authorised official

Name: Jerria Bernestine
Title: Owner
Phone: (310) 756-4829

Registered specialties (4)

Home Infusion Agency Primary

Agencies Taxonomy 251F00000X

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Family Medicine Physician

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X

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Infusion Therapy Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QI0500X

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Family Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LF0000X

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Registry record

NPI: 1003632522
Entity type: Organization
NPI issued: 30 Nov 2024
Record last updated: 30 Nov 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.