Healthcare Provider Details

I. General information

NPI: 1699622969
Provider Name (Legal Business Name): MAGNOLIA ELITE WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CANEBRAKE BLVD STE 110
FLOWOOD MS
39232-2212
US

IV. Provider business mailing address

110 MAGNOLIA PLACE CIR
BRANDON MS
39047-8817
US

V. Phone/Fax

Practice location:
  • Phone: 601-754-1922
  • Fax:
Mailing address:
  • Phone:
  • 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: MARKEIA BENNETT
Title or Position: MANAGER
Credential: NP
Phone: 601-754-1922