Premier Health & Wellness Clinic LLC

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

R853759 Issued in MS

Legal business name

PREMIER HEALTH & WELLNESS CLINIC LLC

Practice address

300 Highland Blvd
Suite B
Natchez, MS 39120-4600

Phone

(601) 304-2421

NPI assigned

Oct 6, 2014

Last updated

Mar 9, 2015By 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

Angie O Waller, FNP

Title

FNP

Phone

(601) 304-2421

Specialties & licenses 1

Addresses

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.

• Raven M. Campbell-Smith, FNP-C

  • Primary Care Nurse Practitioner
  • Natchez, MS
  • NPI 1235544339
  NPD (past)

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

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1558764464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14149",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708984149",
            "telephone_number": "225-930-0060",
            "fax_number": "225-952-9075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HIGHLAND BLVD",
            "address_2": "SUITE B",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391204600",
            "telephone_number": "601-304-2421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HEALTH & WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-06",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "FNP",
        "authorized_official_telephone_number": "601-304-2421",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MS",
            "license": "R853759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Podiatry Associates PLLC
• Bridgett Pollard
• Emily Poole
• Summer Powell, FNP-C
• Premier Health & Wellness Clinic
• Premier Imaging Center, LLC
• Premier Personal Care & Respite Services
• Rachel Kimberly Primm
• Robert Nixon Prospere, DMD
• Thomas L Purvis Jr., M.D.

• Licensed Practical Nurse in Natchez, MS
• Providers in Natchez, MS by specialty
• Licensed Practical Nurse in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.