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General NPI Number Information
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NPI Number | 1154564920
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Entity Type | Organization
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Legal Business Name | ENHANCED WELLNESS OF OAK GROVE, PLLC
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 56 98 PLACE BLVD
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City | HATTIESBURG
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State | MS
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Zip | 39402-8603
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Country | US
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Telephone | 601-264-7286
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Fax | 601-450-4640
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Provider Business Mailing Address
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Address Line | 56 98 PLACE BLVD
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City | HATTIESBURG
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State | MS
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Zip | 39402-8603
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Country | US
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Telephone | 601-264-7286
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Fax | 601-450-4640
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | BETTY LAURA RYBA
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Credential | MSN FNP-BC
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Telephone | 601-264-7286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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