Healthcare Provider Details

I. General information

NPI: 1568301596
Provider Name (Legal Business Name): 5 STAR HEALTH AND WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 KEY PL
COLUMBUS OH
43207-2660
US

IV. Provider business mailing address

7385 STATE ROUTE 3 UNIT 460
WESTERVILLE OH
43082-8654
US

V. Phone/Fax

Practice location:
  • Phone: 281-406-1112
  • Fax: 713-583-2081
Mailing address:
  • Phone: 281-406-1112
  • Fax: 713-583-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OZZIE AMENDA HAIRSTON
Title or Position: OWNER
Credential: DNP,APRN,PMHNP-BC
Phone: 281-406-1112