Healthcare Provider Details

I. General information

NPI: 1407541915
Provider Name (Legal Business Name): INSPIRE HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 SWINNEA RD STE 3
SOUTHAVEN MS
38671-6012
US

IV. Provider business mailing address

7105 SWINNEA RD STE 3 BOX 5
SOUTHAVEN MS
38671
US

V. Phone/Fax

Practice location:
  • Phone: 662-262-8441
  • Fax: 662-996-0198
Mailing address:
  • Phone: 662-262-8441
  • Fax: 662-996-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTAL HILLIE
Title or Position: OWNER
Credential: FNP
Phone: 662-262-8441