Midwest Wound & Wellness LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MIDWEST WOUND & WELLNESS LLC

Practice address

555 W Pine St
Farmington, MO 63640-1439

Phone

(573) 747-1510

Fax

(573) 747-1512

NPI assigned

Jun 18, 2017

Organization subpart

No

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

Authorized official

Name

Kelly M Roberts, FNP

Title

Owner

Phone

(573) 747-1510

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1215467733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W PINE ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401439",
            "telephone_number": "573-747-1510",
            "fax_number": "573-747-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W PINE ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401439",
            "telephone_number": "573-747-1510",
            "fax_number": "573-747-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST WOUND & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-747-1510",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568912129",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Midwest Health Group Convenient Care, LLC
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• Midwest Sleep Lab LLC
• Ashley Marie Miesner, PHARM.D.
• Lee Miesner
• Mikal I. Bell DMD LLC
• Amy Miller, RN
• Anna-Katherine Miller, RN

• All providers in Farmington, MO
• Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.