Healthcare Provider Details

I. General information

NPI: 1851255962
Provider Name (Legal Business Name): IMPACT HEALTH & WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 TRACE COLONY PARK DR STE B
RIDGELAND MS
39157-8810
US

IV. Provider business mailing address

39 TRYSTAN DR
PETAL MS
39465-2806
US

V. Phone/Fax

Practice location:
  • Phone: 601-236-1800
  • Fax:
Mailing address:
  • Phone: 601-236-1800
  • 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: MELISSA WHEATON
Title or Position: PROVIDER/OWNER
Credential: FNP
Phone: 601-236-1800