DESOTO FAMILY WELLNESS CENTER LLC NPI 1376143024

NPI Information

NPI: 1376143024
Provider Name: DESOTO FAMILY WELLNESS CENTER, LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
3495 COBBLESTONE BLVD S
SOUTHAVEN, MS
ZIP 38672
Phone: (662) 892-2885
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DESOTO FAMILY WELLNESS CENTER, LLC is a multi-specialty clinic center in Southaven, MS. DESOTO FAMILY WELLNESS CENTER, LLC NPI is 1376143024. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

3495 COBBLESTONE BLVD S
SOUTHAVEN, MS
ZIP 38672-075
Phone: (662) 892-2885
Fax: (662) 892-2889

The provider's authorized official is Amy Lynn Ollar .
The authorized official title is Office Manager and has the following contact phone number (662) 892-2885.

The enumeration date for this NPI number is 10/30/2020 and was last updated on 9/18/2023.

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	Primary
1	101YP2500X	Counselor	Professional	No
2	103TC1900X	Psychologist	Counseling	No
3	207Q00000X	Family Medicine		No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
5	363LF0000X	Nurse Practitioner	Family	No
6	363LP2300X	Nurse Practitioner	Primary Care	No
7	261QM1300X	Clinic/Center	Multi-Specialty	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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