Southern Magnolia Health and Wellness LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

SOUTHERN MAGNOLIA HEALTH AND WELLNESS LLC

Practice address

533 N Nova Rd Ste 209
Ormond Beach, FL 32174-4422

Phone

(407) 590-0377

NPI assigned

Sep 11, 2020

Organization subpart

No

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

Authorized official

Name

Hope A King, APRN

Title

Owner/Aprn

Phone

(407) 590-0377

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Casie McCallister

  • Family Nurse Practitioner
  • Ormond Beach, FL
  • NPI 1346701406
  NPD (past)

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1871108274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 N YONGE ST",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745252",
            "telephone_number": "407-590-0377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 N NOVA RD STE 209",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321744422",
            "telephone_number": "407-590-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAGNOLIA HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "HOPE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/APRN",
        "authorized_official_telephone_number": "407-590-0377",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.