MEDICARE: ROOTED WELLNESS OF COSHOCTON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1386531259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED WELLNESS OF COSHOCTON LLC

Provider Business Mailing Address
First Line	:	29340 TR 338
Second Line	:
City	:	WARSAW
State	:	OH
Zip	:	43844-9622
Country	:	US
Telephone Number	:	740-294-9223
Fax Number	:	740-294-9223

Provider Business Practice Location Address
First Line	:	1101 CHESTNUT ST
Second Line	:
City	:	COSHOCTON
State	:	OH
Zip	:	43812-1323
Country	:	US
Telephone Number	:	740-294-9223
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	DAWN ELLEN WHITE
Credential	:	APRN, CNP
Telephone Number	:	740-294-9223

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	10/01/2025

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