=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255150280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B WELL HEALTH VENTURES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2024
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4358 OLD SHELL RD STE 177B
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36608-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-298-7111
-----------------------------------------------------
Fax | 251-626-9615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4358 OLD SHELL RD STE 177B
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36608-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-298-7111
-----------------------------------------------------
Fax | 251-626-9615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | MR. TYRONE CORNELLE BARNES
-----------------------------------------------------
Credential | MSN CRNP FNP-BC
-----------------------------------------------------
Telephone | 251-623-1933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------