CK Health && Wellness Lab

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

CK HEALTH && WELLNESS LAB

Practice address

682 Parker PL
Brandon, MS 39042-8493

Phone

(601) 900-2882

NPI assigned

Aug 11, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Jeremy L Clark

Title

Owner

Phone

(601) 900-2882

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1093443673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "682 PARKER PL",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390428493",
            "telephone_number": "601-900-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "682 PARKER PL",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390428493",
            "telephone_number": "601-900-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CK HEALTH && WELLNESS LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-11",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-900-2882",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "CKHEALTHANWELLNES@GMAIL.COM",
            "affiliation": "N",
            "address_1": "682 Parker Pl",
            "city": "Brandon",
            "state": "MS",
            "country_code": "US",
            "postal_code": "390428493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Sonja Childers, PHARMD
• Sudhir Kumar Chiluka, M.D
• Clark Legacy Home Health, LLC
• Christopher Clark
• Eric F Clark Sr.
• Ricky Lynn Clark
• Edward R Clarke

• Health Service Clinic/Center in Brandon, MS
• Providers in Brandon, MS by specialty
• Health Service Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.