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General NPI Number Information
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NPI Number | 1356137905
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Entity Type | Organization
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Legal Business Name | BEWELLNESS, LLC
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1315 OAKRIDGE DR STE 100
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City | FORT COLLINS
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State | CO
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Zip | 80525-7338
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Country | US
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Telephone | 970-829-1129
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Fax | 949-655-8678
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Provider Business Mailing Address
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Address Line | 1315 OAKRIDGE DR STE 100
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City | FORT COLLINS
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State | CO
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Zip | 80525-7338
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Country | US
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Telephone | 970-829-1129
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Fax | 949-655-8678
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Authorized Official
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Title or Position | CEO
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Name | MS. JENNIFER E, KELLER DERAAD
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Credential | APRN
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Telephone | 970-829-1129
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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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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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