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General NPI Number Information
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NPI Number | 1457139016
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH AND WELLNESS
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | VITAL HEALTH AND WELLNESS 2100 CHESTNUT STREET
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City | MONTGOMERY
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State | AL
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Zip | 36106
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Country | US
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Telephone | 334-264-3434
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Fax | 334-834-9071
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Provider Business Mailing Address
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Address Line | VITAL HEALTH AND WELLNESS 2100 CHESTNUT STREET
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City | MONTGOMERY
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State | AL
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Zip | 36106
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Country | US
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Telephone | 334-264-3434
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Fax | 334-834-9071
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Authorized Official
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Title or Position | OWNER
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Name | REGAN OWENS
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Credential | CRNP
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Telephone | 334-264-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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