Indianola Wellness Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

901379 Issued in MS

Legal business name

INDIANOLA WELLNESS CLINIC, LLC

Practice address

131 Main St
Indianola, MS 38751-2849

Phone

(662) 303-3743

NPI assigned

May 15, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Kajuandra K Chandler, NP

Title

Manager/Owner

Phone

(662) 303-3743

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacquelyne Brown Little, FNP

  • Family Nurse Practitioner
  • Indianola, MS
  • NPI 1578020459
  NPD (past)

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

{
    "created_epoch": "1494806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1508393000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 WHITTINGTON DR",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387513434",
            "telephone_number": "662-303-3743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 MAIN ST",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512849",
            "telephone_number": "662-303-3743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANOLA WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-15",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "KAJUANDRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "662-303-3743",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "901379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03321871",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rona Kaye Huey, FNP-C
• Teonia Shantwal Huey
• Indianola Eye Clinic PA
• Indianola Medical Solutions LLC
• Indianola Rehabilitation and Healthcare Center, LLC
• Indywood LLC
• J & J Fedelity Transport Services
• Jackson Personal Care
• Jackson Transportations
• Labrintary Jackson

• Primary Care Clinic/Center in Indianola, MS
• Providers in Indianola, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.