NPIMap

Organization Active NPI

Enhanced Wellness Living PLLC

  • Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1992161954
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R805546 Issued in MS
Legal business name
ENHANCED WELLNESS LIVING PLLC
Practice address
1855 Lakeland Dr
Ste M20
Jackson, MS 39216-4913
Phone
(601) 364-1132
Fax
(601) 364-1134
NPI assigned
Jan 6, 2016
Last updated
Jan 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Authorized official

Name
Mrs. Kelly B Engelmann, CFNPNPI 1710096656
Title
Owner
Phone
(601) 364-1132

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R805546 MS Primary

Addresses

Primary practice location

1855 Lakeland Dr
Ste M20
Jackson, MS 39216-4913

Mailing address

1855 Lakeland Dr
Ste M20
Jackson, MS 39216-4913
Phone (601) 364-1132

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1452038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1992161954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 LAKELAND DR",
            "address_2": "STE M20",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164913",
            "telephone_number": "601-364-1132",
            "fax_number": "601-364-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 LAKELAND DR",
            "address_2": "STE M20",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164913",
            "telephone_number": "601-364-1132",
            "fax_number": "601-364-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENHANCED WELLNESS LIVING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-06",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "ENGELMANN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-364-1132",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R805546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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.