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General NPI Number Information
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NPI Number | 1215648670
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Entity Type | Organization
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Legal Business Name | SALT AND LIGHT HOLISTIC HEALTH
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Dates
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Enumeration Date | 12/07/2022
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 2001 CLUB MANOR DR STE D
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City | MAUMELLE
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State | AR
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Zip | 72113-7417
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Country | US
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Telephone | 501-765-8390
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Fax |
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Provider Business Mailing Address
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Address Line | 21415 CHISM DR
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72113-9705
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Country | US
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Telephone | 501-765-8390
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/CEO
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Name | STEPHANIE LANELL BURNETT
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Credential | APRN
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Telephone | 501-765-8390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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