Healthcare Provider Details

I. General information

NPI: 1063178853
Provider Name (Legal Business Name): ENM WELLNESS & MORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 TAYLOR BLVD
LOUISVILLE KY
40215-2648
US

IV. Provider business mailing address

4205 NANEEN DR
LOUISVILLE KY
40216-3973
US

V. Phone/Fax

Practice location:
  • Phone: 502-365-2340
  • Fax: 502-365-3063
Mailing address:
  • Phone: 502-314-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERICA MAHONE
Title or Position: OWNER/PROVIDER
Credential: APRN
Phone: 502-314-1247