=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316801426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INNERFLOW FAMILY WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2025
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 HAWTHORNE RD
-----------------------------------------------------
City | NEW WAVERLY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77358-3834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-496-2523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 HAWTHORNE RD
-----------------------------------------------------
City | NEW WAVERLY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77358-3834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-496-2523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOLISTIC WELLNESS EDUCATOR
-----------------------------------------------------
Name | JACQUELYN L WILSON
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 713-496-2523
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------