INDIANOLA WELLNESS CLINIC, LLC (NPI# 1508393000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508393000 |
| Entity Type | Organization |
| Organization Name | INDIANOLA WELLNESS CLINIC, LLC |
| Practice Address |
131 Main St Indianola MS 38751-2849 |
| Mailing Address |
108 Whittington Dr Indianola MS 38751-3434 |
| Practice Telephone | 6623033743 |
| Mailing Telephone | 6623033743 |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | MS. KAJUANDRA K CHANDLER (MANAGER/OWNER) |
| Authorized Official Telephone | 6623033743 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
901379 | MS | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 03321871 | 05 |
| Street Address |
131 MAIN ST |
| City | INDIANOLA |
| State | MS |
| Zip Code | 38751-2849 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578020459 | Jacquelyne D Brown | Nurse Practitioner | 131 Main St, Indianola, MS 38751-2849 | 2019-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649781253 | Greater Hearts Adult Daycare | Clinic/Center | 124 Curtis Street, Indianola, MS 38751 | 2017-10-23 |
| 1083139505 | Quality Family Care LLC | Nurse Practitioner | 310 Hwy 82 West, Suite D, Indianola, MS 38751 | 2017-08-05 |
| 1932641800 | Creative Image Personal Care Services LLC | Respite Care | 503 Hwy 82 East, Indianola, MS 38751 | 2016-11-09 |
| 1225580442 | St. John's Respite Care Services, LLC | In Home Supportive Care | 517 East Street, Indianola, MS 38751 | 2016-11-04 |
| 1992163588 | Rona Kaye Huey | Nurse Practitioner | 310 Highway 82 W Ste D, Indianola, MS 38751 | 2016-02-10 |
| 1952641201 | Julia R. Hill, Dmd, Pa | Dentist | 104 W. Gresham St., Indianola, MS 38751 | 2013-02-25 |
| 1649463977 | Kenneth C Beal Jr. | Dentist | 913 B.b. King Road, Indianola, MS 38751 | 2007-08-21 |
| 1922136688 | Lloyd Leon Patton Jr. | Pharmacist | 903 Highway 82 East, Building G, Indianola, MS 38751 | 2007-03-02 |
| 1770623506 | North Mississippi Foot Specialists PC | Durable Medical Equipment & Medical Supplies | 110 East Baker Street, Indianola, MS 38751 | 2007-02-08 |
| 1548311525 | Quality In Home Services Inc | Homemaker | 108 Martin Luther King, Indianola, MS 38751 | 2007-01-16 |
| Find all providers in zip 38751 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
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| 1528087418 | Mercy Clinics Inc | Clinic/Center | 307 E. Scenic Valley Ave, Indianola, IA 50125-4865 | 2006-07-19 |
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| 1710545488 | Primary and Behavioral Healthcare Services, Pa | Clinic/Center | 717 E. Fortification St., Jackson, MS 39202-2402 | 2019-05-29 |
| 1720559354 | Golden Years Geriatrics Inc. | Clinic/Center | 1233 County Road 108, New Albany, MS 38652-9787 | 2018-12-07 |
| 1316421373 | Children's International, LLC | Clinic/Center | 2003 Wildwood Rd, Picayune, MS 39466-2178 | 2018-09-17 |
| 1124505912 | Thaxton Family Medical Clinic LLC | Clinic/Center | 11145 Highway 6 W, Thaxton, MS 38871-9024 | 2018-07-24 |
| 1316439615 | Quad/med, LLC | Clinic/Center | 1000 Jere St. Pe' Hwy, C/o Ingalls Main Substation, 1st Floor, Pascagoula, MS 39567 | 2018-06-01 |
| 1194215681 | Brooks Medical Clinic | Clinic/Center | 2113 South Tate Street, Corinth, MS 38834 | 2018-05-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.