Healthcare Provider Details

I. General information

NPI: 1013637917
Provider Name (Legal Business Name): WELLBEAN HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N HER WAY
SAINT DAVID AZ
85630
US

IV. Provider business mailing address

PO BOX 37
SAINT DAVID AZ
85630-0037
US

V. Phone/Fax

Practice location:
  • Phone: 520-222-8096
  • Fax:
Mailing address:
  • Phone: 520-222-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN ROE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 617-674-3499