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General NPI Number Information
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NPI Number | 1235749359
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Entity Type | Organization
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Legal Business Name | JM WELLNESS, LLC
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 201 DONAGHEY AVE
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City | CONWAY
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State | AR
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Zip | 72035-5001
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Country | US
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Telephone | 501-733-6575
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 APPLEWOOD DR
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City | CONWAY
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State | AR
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Zip | 72034-3538
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Country | US
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Telephone | 501-733-6575
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY MAYO
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Credential | PHD, RD
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Telephone | 501-733-6575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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