Wellvana Maryland, LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

WELLVANA MARYLAND, LLC

Practice address

4840 Centennial Blvd Ste 202
Nashville, TN 37209-1792

Phone

(860) 501-7908

NPI assigned

Jun 29, 2022

Organization subpart

Yes

Parent organization

WELLVANA HEALTHAs reported in NPPES

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

Authorized official

Name

Kyle Wailes

Title

Ceo

Phone

(401) 378-7336

Specialties & licenses 1

Addresses

Part of

Wellvana Health

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Wellvana Health

  • Exclusive Provider Organization
  • Nashville, TN
  • NPI 1023618378
  NPPES parent name

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

{
    "created_epoch": "1656460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1699407502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 CENTENNIAL BLVD STE 202",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372091792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 CENTENNIAL BLVD STE 202",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372091792",
            "telephone_number": "860-501-7908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLVANA MARYLAND, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLVANA HEALTH",
        "enumeration_date": "2022-06-29",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "WAILES",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "401-378-7336"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wellvana Essential Care, LLC
• Wellvana Florida LLC
• Wellvana Georgia LLC
• Wellvana Health
• Wellvana Louisiana LLC
• Wellvana Michigan LLC
• Wellvana Mississippi LLC
• Wellvana New Mexico LLC
• Wellvana New Mexico LLC
• Wellvana North Carolina, LLC

• Preferred Provider Organization in Nashville, TN
• Providers in Nashville, TN by specialty
• Preferred Provider Organization in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.