Healthy Body LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

71006194A Issued in IN

Legal business name

HEALTHY BODY LLC

Practice address

2515 Ladue LN
Fort Wayne, IN 46804-2796

Phone

(925) 518-6122

NPI assigned

Jul 18, 2017

Organization subpart

No

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

Authorized official

Name

Mollie McDaniel Mowery, NP-C

Title

Owner

Phone

(925) 518-6122

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500336000000",
    "number": "1508389990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7619 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044133",
            "telephone_number": "260-407-8006",
            "fax_number": "260-407-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 LADUE LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042796",
            "telephone_number": "925-518-6122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY BODY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-18",
        "last_updated": "2017-07-18",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL MOWERY",
        "authorized_official_first_name": "MOLLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-518-6122",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71006194A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Gerontology Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2017; 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.