NPIMap

Organization Active NPI

Wellness Legacy LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bel Air, MD
National Provider Identifier
1265039549
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
WELLNESS LEGACY LLC
Practice address
260 Gateway Dr Ste 13
Bel Air, MD 21014-4268
Phone
(410) 286-1258
NPI assigned
Oct 8, 2020
Last updated
Mar 27, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLNESS LEGACY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Authorized official

Name
Lera Ison, CRNP- FNPI 1952787400
Title
Co- Owner
Phone
(410) 286-1258

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

260 Gateway Dr Ste 13
Bel Air, MD 21014-4268

Mailing address

1539 Blakes Legacy Dr
Bel Air, MD 21014-1946
Phone (817) 319-6878

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL lison@wellnesslegacy.co

National Provider Directory

National Provider Directory
Tax ID family
Wellness Legacy LLC3 organizations share this tax ID, including this one
Part of
Wellness Legacy LLC

Other organizations with this tax ID 2

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

Locations

260 Gateway Dr
Ste 1314B
Bel Air, MD 21014
Phone (410) 286-1258

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": "1602115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1265039549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 BLAKES LEGACY DR",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210141946",
            "telephone_number": "817-319-6878",
            "fax_number": "443-231-3684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 GATEWAY DR STE 13",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144268",
            "telephone_number": "410-286-1258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS LEGACY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLNESS LEGACY LLC",
        "enumeration_date": "2020-10-08",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "ISON",
        "authorized_official_first_name": "LERA",
        "authorized_official_title_or_position": "CO- OWNER",
        "authorized_official_telephone_number": "410-286-1258",
        "authorized_official_credential": "CRNP- F"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "lison@wellnesslegacy.co",
            "affiliation": "N",
            "address_1": "260 Gateway Dr Ste 13-14B",
            "city": "Bel Air",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210144268",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bel Air, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; 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.