Healthcare Provider Details

I. General information

NPI: 1851180046
Provider Name (Legal Business Name): A1 INTEGRATED WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 S CONKLING ST
BALTIMORE MD
21224-4201
US

IV. Provider business mailing address

526 S CONKLING ST
BALTIMORE MD
21224-4201
US

V. Phone/Fax

Practice location:
  • Phone: 240-433-3557
  • Fax:
Mailing address:
  • Phone: 240-433-3557
  • Fax: 463-362-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JYLLA DEANE ARTIS
Title or Position: CEO
Credential: CRNP
Phone: 443-226-0748