Healthcare Provider Details

I. General information

NPI: 1336062090
Provider Name (Legal Business Name): VITAL WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 H20 PL STE 4
HAMPSTEAD NC
28443-3066
US

IV. Provider business mailing address

95 H20 PL STE 4
HAMPSTEAD NC
28443-3066
US

V. Phone/Fax

Practice location:
  • Phone: 910-410-4928
  • Fax: 910-996-5831
Mailing address:
  • Phone: 910-410-4928
  • Fax: 910-996-5831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE KITTRELL
Title or Position: OWNER
Credential: PA
Phone: 910-410-4928