Medical Assisted Wellness LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

MEDICAL ASSISTED WELLNESS LLC

Practice address

121 Wyatt Dr Ste 3
Las Cruces, NM 88005-2960

Phone

(575) 495-2000

Fax

(575) 495-2000

NPI assigned

Aug 21, 2017

Last updated

Oct 13, 2017By 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

Mr. Justin Montgomery, NP

Title

Owner

Phone

(423) 388-5688

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507852800000",
    "number": "1649796699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4216 AURIGA CT",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880110940",
            "telephone_number": "423-388-5688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 WYATT DR STE 3",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880052960",
            "telephone_number": "575-495-2000",
            "fax_number": "575-495-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL ASSISTED WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-21",
        "last_updated": "2017-10-13",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-388-5688",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.