Healthwise 360 LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

HEALTHWISE 360 LLC

Practice address

8 Stonebridge Blvd Ste M
Jackson, TN 38305-2178

Phone

(731) 267-2836

NPI assigned

Mar 16, 2017

Organization subpart

No

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

Authorized official

Name

Kristie Gutgsell

Title

Owner/Operator

Phone

(731) 736-4300

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1489622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567987200000",
    "number": "1376084814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 BOLEN AVE",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383401521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 STONEBRIDGE BLVD STE M",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052178",
            "telephone_number": "731-267-2836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHWISE 360 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-16",
        "last_updated": "2019-09-09",
        "status": "A",
        "authorized_official_last_name": "GUTGSELL",
        "authorized_official_first_name": "KRISTIE",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "731-736-4300"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q027339",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Jackson, TN
• Providers in Jackson, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2019; 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.