Victory Wellness Center, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

R866985 Issued in MS

Legal business name

VICTORY WELLNESS CENTER, LLC

Practice address

123 Caillavet St
Biloxi, MS 39530-4101

Phone

(228) 386-7487

Fax

(228) 386-7499

NPI assigned

Jan 26, 2010

Organization subpart

No

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

Authorized official

Name

Suporior R Harris, CRNP

Title

C.E.O./ Certified Nurse Practitione

Phone

(251) 610-2644

Specialties & licenses 1

Addresses

Other names 1

• VICTORY WELLNESS CENTER, LLC Other name

Locations

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

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264464000000",
    "number": "1255662516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8556",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395358556",
            "telephone_number": "251-610-2644",
            "fax_number": "251-639-9707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 CAILLAVET ST",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395304101",
            "telephone_number": "228-386-7487",
            "fax_number": "228-386-7499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-26",
        "last_updated": "2010-01-26",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "SUPORIOR",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "C.E.O./ CERTIFIED NURSE PRACTITIONE",
        "authorized_official_telephone_number": "251-610-2644",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "R866985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VICTORY WELLNESS CENTER, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kristi Verret
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• Robin Rashaun Vidal, PHARM D
• Jada Elyse Vierling Hill, WHNP-BC
• Vincent J Kuluz (Economy Drugs)
• Vincent J Kuluz (Economy Drugs)
• Luzdivina Ana Vine, M.D.

• Clinic/Center in Biloxi, MS
• Providers in Biloxi, MS by specialty
• Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; 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.