Healthcare Provider Details

I. General information

NPI: 1285503839
Provider Name (Legal Business Name): TRUE ESSENCE HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E DONALD ST STE 1
QUITMAN MS
39355-2310
US

IV. Provider business mailing address

590 HIGHWAY 18 W
QUITMAN MS
39355-8739
US

V. Phone/Fax

Practice location:
  • Phone: 601-934-9629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAKISHA GIBSON
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 601-934-9629