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General NPI Number Information
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NPI Number | 1033989330
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Entity Type | Organization
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Legal Business Name | DESIGN YOUR WELLNESS, LLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 7040 WIND STONE BLVD STE 150
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-9090
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Country | US
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Telephone | 662-874-5828
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1663
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-0965
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Country | US
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Telephone | 662-874-5828
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Fax |
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Authorized Official
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Title or Position | OWNER & NURSE PRACTITIONER
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Name | KAMIKA WALL
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Credential | APRN
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Telephone | 662-874-5828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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