VITAL WELLNESS CLINIC LLC NPI 1013528017

NPI Information

NPI: 1013528017
Provider Name: VITAL WELLNESS CLINIC LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 04D2194476

Address:
4001 COMMERCIAL CENTER DR STE 1
MARION, AR
ZIP 72364
Phone: (870) 636-9218
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VITAL WELLNESS CLINIC LLC is a family nurse practitioner in Marion, AR. VITAL WELLNESS CLINIC LLC NPI is 1013528017. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4001 COMMERCIAL CENTER DR STE 1
MARION, AR
ZIP 72364-616
Phone: (870) 636-9218

The provider's authorized official is Kristy Anne Whited .
The authorized official title is Co-owner and has the following contact phone number (870) 636-9218.

The CLIA number assigned to this NPI record is 04D2194476 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/12/2020 and was last updated on 12/16/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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