ENHANCED WELLNESS OF OAK GROVE PLLC NPI 1154564920

NPI Information

ENHANCED WELLNESS OF OAK GROVE, PLLC is a family nurse practitioner in Hattiesburg, MS. ENHANCED WELLNESS OF OAK GROVE, PLLC NPI is 1154564920. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

56 98 PLACE BLVD
HATTIESBURG, MS
ZIP 39402-603
Phone: (601) 264-7286
Fax: (601) 450-4640

The provider's authorized official is Betty Laura Ryba .
The authorized official title is Provider/owner and has the following contact phone number (601) 264-7286.

The CLIA number assigned to this NPI record is 25D1096216 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/9/2009 and was last updated on 11/15/2021.

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:

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