Serenitypass Holistic Health PLLC
Organization Active NPI Family Nurse Practitioner · Sandoval, IL
NPI 1639935281 · NPPES record last updated Dec 16, 2024
Key facts
- NPI
- 1639935281
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- SERENITYPASS HOLISTIC HEALTH PLLC
- Practice address
- 605 N Mine St
Sandoval, IL 62882-1103 - Phone
- (618) 552-3034
- NPI assigned
- Feb 22, 2024
- Organization subpart
- No
Authorized official
- Name
- Kelly Hall, NP
- Title
- Owner
- Phone
- (937) 577-4266
Practitioners 2
-
Shelby Guthrie, FNP
-
Kelly Ruth Hall, NP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240515002838 | IL | Part B Supplier - Clinic/Group Practice | 7618318130 |
Receives reassigned benefits from 2 practitioners Practice locations: Odin, IL; Sandoval, IL |
National Provider Directory
Locations
605 N Mine St
Sandoval, IL 62882
Phone (618) 552-3034
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
605 N Mine St
Sandoval, IL 62882-1103
Mailing address
605 N Mine St
Sandoval, IL 62882-1103
Phone (618) 552-3034
Other practice location 1
1631 Robinett Rd
Odin, IL 62870-2109
Phone (618) 552-3034
Other providers in Sandoval, IL
- Kelly Ruth Hall
- William J Henson
- Sandoval CC SCH Dist 501
- Sandoval Volunteer Fire Dept
- Rama M Seats
- Kenzi Wood
All providers in Sandoval, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.