Executive Level Wellness

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

APN013215 Issued in TN

Legal business name

EXECUTIVE LEVEL WELLNESS

Practice address

111 Stonebridge Blvd
Jackson, TN 38305-2040

Phone

(731) 420-3334

Fax

(888) 318-1702

NPI assigned

Apr 22, 2015

Organization subpart

No

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

Authorized official

Name

David Brian Hughes, GNP-BC

Title

Owner

Phone

(731) 571-8808

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1265829626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1167 JR JONES RD",
            "city": "HUMBOLDT",
            "state": "TN",
            "postal_code": "383438080",
            "telephone_number": "731-571-8808",
            "fax_number": "888-318-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 STONEBRIDGE BLVD",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052040",
            "telephone_number": "731-420-3334",
            "fax_number": "888-318-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE LEVEL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-22",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-571-8808",
        "authorized_official_credential": "GNP-BC"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "APN013215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kay Eubanks, CASE MANAGER
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• Caroline Evans, SLP
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• John E Everett, MD
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• Skilled Nursing Facility in Jackson, TN
• Providers in Jackson, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; 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.