=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124940986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED HEALTH & WELLNESS PRACTICE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2026
-----------------------------------------------------
Last Update Date | 07/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 557 PROSPECT AVE FL 1-1004
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-2965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-238-1446
-----------------------------------------------------
Fax | 413-216-2939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1425
-----------------------------------------------------
City | SOUTHWICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01077-1425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-238-1446
-----------------------------------------------------
Fax | 413-216-2939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | LISA KILLIPS
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 413-238-1446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------