Healthcare Provider Details

I. General information

NPI: 1437012473
Provider Name (Legal Business Name): ADVANCECARE REMOTE HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 RUSSELL PKWY STE 31
WARNER ROBINS GA
31088-8681
US

IV. Provider business mailing address

520 GA HIGHWAY 247 S # 160
BONAIRE GA
31005-3886
US

V. Phone/Fax

Practice location:
  • Phone: 478-403-3295
  • Fax:
Mailing address:
  • Phone: 478-403-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KOURTNEY INGRAM
Title or Position: OWNER/NURSE PRACTITIONER
Credential: NP
Phone: 478-403-3295