Organization Active NPI

Wellness and Aesthetics LLC

  • Family Nurse Practitioner
  • Las Cruces, NM
National Provider Identifier
1508482316
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
WELLNESS AND AESTHETICS LLC
Practice address
705 N Alameda Blvd
Las Cruces, NM 88005-2128
Phone
(575) 288-1336
Fax
(323) 334-1449
NPI assigned
Jun 18, 2020
Last updated
Dec 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

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

Authorized official

Name
Danielle Castillo
Title
Credentialing Specialist
Phone
(575) 288-1336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

705 N Alameda Blvd
Las Cruces, NM 88005-2128

Mailing address

705 N Alameda Blvd
Las Cruces, NM 88005-2128
Phone (575) 288-1336

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL charmhealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201012001177 NM Part B Supplier - Clinic/Group Practice 6901226026 Receives reassigned benefits from 1 practitioner
Practice locations: Las Cruces, NM

National Provider Directory

National Provider Directory

Locations

705 N Alameda Blvd
Las Cruces, NM 88005
Phone (575) 288-1336

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734652800000",
    "number": "1508482316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 N ALAMEDA BLVD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880052128",
            "telephone_number": "575-288-1336",
            "fax_number": "323-334-1449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 N ALAMEDA BLVD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880052128",
            "telephone_number": "575-288-1336",
            "fax_number": "323-334-1449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS AND AESTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-18",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "575-288-1336"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "charmhealth.com",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "address_1": "330 N Campo St",
            "city": "Las Cruces",
            "state": "NM",
            "country_code": "US",
            "postal_code": "880013433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.