Healthcare Provider Details

I. General information

NPI: 1497619415
Provider Name (Legal Business Name): VIRTUAL HEALTH AND WELL-BEING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E WOOD ST
ASHDOWN AR
71822-3648
US

IV. Provider business mailing address

6213 SUMMERHILL PL
TEXARKANA TX
75503-1500
US

V. Phone/Fax

Practice location:
  • Phone: 870-260-7570
  • Fax:
Mailing address:
  • Phone: 903-276-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LATERICA K HOUSE
Title or Position: OWNER
Credential:
Phone: 903-276-1529