NPIMap

Organization Active NPI

Free State Health and Wellness, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Frederick, MD
National Provider Identifier
1093389744
Registry record updated Aug 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
FREE STATE HEALTH AND WELLNESS, LLC
Practice address
365 W Patrick St FL 205
Frederick, MD 21701-5093
Phone
(240) 647-9049
Fax
(240) 690-6095
NPI assigned
May 17, 2021
Last updated
Aug 14, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FREE STATE HEALTH AND WELLNESS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2026

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

Authorized official

Name
Melissa WardNPI 1568848687
Title
Owner
Phone
(240) 647-9049

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

365 W Patrick St FL 205
Frederick, MD 21701-5093

Mailing address

365 W Patrick St FL 205
Frederick, MD 21701-5093
Phone (240) 647-9049

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171019000109 MD Part B Supplier - Clinic/Group Practice 5294001210 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Nottingham, MD; Frederick, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Free State HLTH Well LLC2 organizations share this tax ID, including this one
Part of
Free State HLTH Well LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5 N Bentz St
Frederick, MD 21701
Phone (240) 575-6210

7652 Belair Rd
Ste A
Nottingham, MD 21236
Phone (410) 508-0722

9608 Belair Rd
#3
Nottingham, MD 21236
Phone (240) 647-9049

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1621209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786665600000",
    "number": "1093389744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 W PATRICK ST FL 205",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217015093",
            "telephone_number": "240-647-9049",
            "fax_number": "240-690-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 W PATRICK ST FL 205",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217015093",
            "telephone_number": "240-647-9049",
            "fax_number": "240-690-6095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREE STATE HEALTH AND WELLNESS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREE STATE HEALTH AND WELLNESS, LLC",
        "enumeration_date": "2021-05-17",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-647-9049"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.