Enchanted Hills Health and Wellness Center LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

ENCHANTED HILLS HEALTH AND WELLNESS CENTER LLC

Practice address

1356 25TH St
Newport News, VA 23607-4826

Phone

(757) 405-6060

NPI assigned

Apr 24, 2024

Last updated

Apr 24, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly McKissackNPI 1720490386

Title

Owner

Phone

(757) 405-6060

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Kimberly McKissack, NP

  • Primary Care Nurse Practitioner
  • Hampton, VA
  • NPI 1720490386
  NPD Authorized official

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

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1437905155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 MANNING LN",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1356 25TH ST",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236074826",
            "telephone_number": "757-405-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENCHANTED HILLS HEALTH AND WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-24",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "MCKISSACK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-405-6060"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Nurse Practitioner in Newport News, VA
• Providers in Newport News, VA by specialty
• Primary Care Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.