NPIMap

Organization Active NPI

Holistic Wellness Group LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Fredericksburg, VA
National Provider Identifier
1962199745
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
HOLISTIC WELLNESS GROUP LLC
Practice address
6308 Five Mile Centre Park Ste 217
Fredericksburg, VA 22407-5508
Phone
(571) 409-8390
NPI assigned
Apr 20, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Authorized official

Name
Emigdus Nkem
Title
Director
Phone
(571) 494-7066

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Infusion Therapy Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WI0500X
Home Infusion Agency 251F00000X
Infusion Therapy Clinic/Center 261QI0500X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

6308 Five Mile Centre Park Ste 217
Fredericksburg, VA 22407-5508

Mailing address

12806 Glendale CT
Fredericksburg, VA 22407-2060
Phone (571) 409-8390

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230608002763 VA Part B Supplier - Clinic/Group Practice 0547627366 Receives reassigned benefits from 6 practitioners
Practice locations: Fredericksburg, VA

National Provider Directory

National Provider Directory

Locations

6308 Five Mile Centre Park
Ste 217
Fredericksburg, VA 22407
Phone (571) 359-8782

6308 Five Mile Centre Park
Ste 219
Fredericksburg, VA 22407
Phone (540) 642-0883

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1681948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1962199745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12806 GLENDALE CT",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224072060",
            "telephone_number": "571-409-8390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6308 FIVE MILE CENTRE PARK STE 217",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224075508",
            "telephone_number": "571-409-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLISTIC WELLNESS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-20",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "NKEM",
        "authorized_official_first_name": "EMIGDUS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "571-494-7066"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WI0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.