=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396679254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPREME HEALTH AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2026
-----------------------------------------------------
Last Update Date | 06/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9331 W CROWN KING RD
-----------------------------------------------------
City | TOLLESON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85353-5573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-514-6368
-----------------------------------------------------
Fax | 602-560-7326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2632 S 83RD AVE STE 100
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85043-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-514-6368
-----------------------------------------------------
Fax | 602-560-7326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER
-----------------------------------------------------
Name | DR. SHERRI ANN RHODES
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 304-237-0933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------