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General NPI Number Information
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NPI Number | 1295387595
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Entity Type | Organization
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Legal Business Name | WYTHE WELLNESS INC
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 325 E MAIN ST STE B
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City | WYTHEVILLE
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State | VA
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Zip | 24382-2300
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Country | US
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Telephone | 931-284-1362
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 65
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City | WYTHEVILLE
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State | VA
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Zip | 24382-0065
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Country | US
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Telephone | 931-284-1362
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | JAMES WADE BOLTON
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Credential | DC, NP
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Telephone | 931-284-1362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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