=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679462337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAND PRAIRIE WELLNESS CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2025
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 W 22ND ST
-----------------------------------------------------
City | STUTTGART
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72160-6600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-837-4337
-----------------------------------------------------
Fax | 844-689-3150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 SWAN B LN
-----------------------------------------------------
City | STUTTGART
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72160-5653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-837-4337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHRYN MORRIS
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 501-837-4337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------