Bodhi Wellness, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

BODHI WELLNESS, LLC

Practice address

1331 Willow Wood Dr
Norfolk, VA 23509-1303

Phone

(757) 239-5858

NPI assigned

May 12, 2025

Organization subpart

No

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

Authorized official

Name

Shannon Coulson, NPNPI 1295237477

Title

Owner

Phone

(757) 239-5858

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Tax ID family

Bodhi Wellness LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bodhi Wellness LLC

  • Nurse Practitioner
  • La Break, VA
  • NPI 1285426718
  NPD tax ID

Locations

Practitioners 2

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

• Shannon Coulson, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Norfolk, VA
  • NPI 1295237477
  Medicare reassignment Care Compare group NPD Authorized official
• Mackenzie Rourke, NCC, LPC

  • Professional Counselor
  • Frederick, MD
  • NPI 1649118662

  VA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1747008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1982494837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 COLLEY AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235082067",
            "telephone_number": "757-681-6634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 WILLOW WOOD DR",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235091303",
            "telephone_number": "757-239-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODHI WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-12",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "COULSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-239-5858",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BMR-1 VA, LLC
• Kristina Boarts, DPT, CERT MDT
• Silvina M. Bocca, MD
• David Scott Bockelman, IDC
• Daniel Boczar Lins Santana, MD
• Bruce Ira Bodner, MD
• Lee Irvin Boehm, PT
• Kelly Boettcher
• Valencia Vasquez Bogan, BCAT
• Gary Walker Boggus, M.D.

• Nurse Practitioner in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; 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.