Vital Wellness Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

VITAL WELLNESS CLINIC LLC

Practice address

4001 Commercial Center Dr Ste 1
Marion, AR 72364-9616

Phone

(870) 636-9218

NPI assigned

Aug 12, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kristy Anne Whited, APRNNPI 1134643190

Title

Co-Owner

Phone

(870) 636-9218

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristy Anne Whited, FNP-C

  • Family Nurse Practitioner
  • Marion, AR
  • NPI 1134643190
  Medicare reassignment Care Compare group NPD Authorized official
• Fallon E Wyatt

  • Family Nurse Practitioner
  • Marion, AR
  • NPI 1093191819
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1013528017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 COMMERCIAL CENTER DR STE 1",
            "city": "MARION",
            "state": "AR",
            "postal_code": "723649616",
            "telephone_number": "870-636-9218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 COMMERCIAL CENTER DR STE 1",
            "city": "MARION",
            "state": "AR",
            "postal_code": "723649616",
            "telephone_number": "870-636-9218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "WHITED",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "870-636-9218",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Marion, AR
• Providers in Marion, AR by specialty
• Family Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.