Healthcare Provider Details

I. General information

NPI: 1821349895
Provider Name (Legal Business Name): LIFE HEALTH AND WELLNESS HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 N 15TH AVE STE 105
PHOENIX AZ
85015-3329
US

IV. Provider business mailing address

PO BOX 974
GLENDALE AZ
85311-0974
US

V. Phone/Fax

Practice location:
  • Phone: 888-958-5736
  • Fax: 888-958-5737
Mailing address:
  • Phone: 888-958-5736
  • Fax: 888-958-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP 3114
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1705
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1707
License Number StateAZ

VIII. Authorized Official

Name: DR. BEVERLY THOMAS-CARTER
Title or Position: PRESIDENT
Credential: DNP,FNP-BC
Phone: 888-958-5736