Healthcare Provider Details

I. General information

NPI: 1548125164
Provider Name (Legal Business Name): ARISE WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 PANTHER WAY
INDIANAPOLIS IN
46237-9471
US

IV. Provider business mailing address

6707 PANTHER WAY
INDIANAPOLIS IN
46237-9471
US

V. Phone/Fax

Practice location:
  • Phone: 317-851-0966
  • Fax: 317-934-1694
Mailing address:
  • Phone: 317-851-0966
  • Fax: 317-934-1694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSI WILD
Title or Position: CREDENTIALING
Credential: LMHC
Phone: 317-279-5583