Country Club Medical Weight Loss & Wellness PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

COUNTRY CLUB MEDICAL WEIGHT LOSS & WELLNESS PLLC

Practice address

1855 S Country Club Dr Ste 111-130
Mesa, AZ 85210-6037

Phone

(480) 840-4777

NPI assigned

Oct 5, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Flora Issanda Stowater, NPNPI 1700274321

Title

Owner/Manager

Phone

(480) 840-4777

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Flora Issanda Stowater, NP

  • Nurse Practitioner
  • Mesa, AZ
  • NPI 1700274321

  Family

  NPD Authorized official

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

{
    "created_epoch": "1696464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1205616398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 697",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853390697",
            "telephone_number": "480-840-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 S COUNTRY CLUB DR STE 111-130",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106037",
            "telephone_number": "480-840-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB MEDICAL WEIGHT LOSS & WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-05",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "ISSANDA STOWATER",
        "authorized_official_first_name": "FLORA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "480-840-4777",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Farrell Coughlin, MD
• Country Club Chiropractic LLC
• Country Club Dental Inc.
• Country Club Dental Management Co, PC
• Country Club Medical Group P C
• Country Oaks
• Cherise Courtright
• Pete S Coury, MD
• Blaine Rodney Couser, DDS, MS
• Taylor Faith Cova

• Family Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.