Healthcare Provider Details

I. General information

NPI: 1083594881
Provider Name (Legal Business Name): WISH U WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54366 SHOAL CRK
LA QUINTA CA
92253-4773
US

IV. Provider business mailing address

54366 SHOAL CRK
LA QUINTA CA
92253-4773
US

V. Phone/Fax

Practice location:
  • Phone: 404-683-0095
  • Fax: 404-683-0095
Mailing address:
  • Phone: 404-683-0095
  • Fax: 404-683-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: MRS. KERRY B MCKENZIE
Title or Position: OWNER
Credential: NATUROPATH
Phone: 404-683-0095