Healthcare Provider Details

I. General information

NPI: 1164350625
Provider Name (Legal Business Name): ELEVATE TELEHEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 GLADSTONE LN
CLINTON MS
39056-5949
US

IV. Provider business mailing address

109 GLADSTONE LN
CLINTON MS
39056-5949
US

V. Phone/Fax

Practice location:
  • Phone: 601-613-5338
  • Fax:
Mailing address:
  • Phone: 601-613-5338
  • Fax:

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: DEMETRIA REED
Title or Position: OWNER
Credential: NP
Phone: 601-613-5338