Healthcare Provider Details

I. General information

NPI: 1285456640
Provider Name (Legal Business Name): BOLD BEGINNINGS WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8087 CINCINNATI DAYTON RD STE A
WEST CHESTER OH
45069-2003
US

IV. Provider business mailing address

10948 STATE ROUTE 73
NEW VIENNA OH
45159-9524
US

V. Phone/Fax

Practice location:
  • Phone: 937-527-6239
  • Fax:
Mailing address:
  • Phone: 937-527-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHEYENNE M GASAWAY
Title or Position: CEO
Credential: APRN, BCADM
Phone: 937-527-6239