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General NPI Number Information
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NPI Number | 1487497897
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Entity Type | Organization
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Legal Business Name | OPTIMUM WELLNESS & HYDRATION, LLC
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Dates
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Enumeration Date | 06/13/2024
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 16 MEDICAL CENTER DR
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City | MONROEVILLE
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State | AL
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Zip | 36460-3036
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Country | US
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Telephone | 251-239-9198
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1318
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City | MONROEVILLE
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State | AL
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Zip | 36461-1318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | KIMBERLY BRIGHT
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Credential | NP
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Telephone | 251-593-6171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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