830 Wellness, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

830 WELLNESS, LLC

Practice address

2210 Bandera Hwy Ste C-2
Kerrville, TX 78028-6609

Phone

(903) 576-5677

NPI assigned

Mar 20, 2023

Organization subpart

No

Name

Mrs. Lacy McMillon, APRN, FNP-C, ENP-CNPI 1316321748

Title

Owner

Phone

(903) 576-5677

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

• Lacy McMillon, APRN, FNP-C, ENP-C

  • Family Nurse Practitioner
  • Bandera, TX
  • NPI 1316321748

  TX

  Medicare reassignment NPD Authorized official
• Hailey Huser, FNP

  • Family Nurse Practitioner
  • Kerrville, TX
  • NPI 1235055286
  NPD (past)
• Stephanie Lynn Williams

  • Nurse Practitioner
  • San Antonio, TX
  • NPI 1043997547
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 20, 2023.

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1649972043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 LARIAT TRACE",
            "city": "BANDERA",
            "state": "TX",
            "postal_code": "78003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 BANDERA HWY STE C-2",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286609",
            "telephone_number": "903-576-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "830 WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "MCMILLON",
        "authorized_official_first_name": "LACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-576-5677",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN, FNP-C, ENP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regina Teresa Acevedo
• Ackman Pharmacy Inc
• Steve Ackman
• Luis Jose Acosta, M.D.
• Aeg Texas Professional PLLC

• All providers in Kerrville, TX
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; 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.