=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750161964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNOLO WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2023
-----------------------------------------------------
Last Update Date | 04/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21284 MEADOWS ACRES DR
-----------------------------------------------------
City | HENSLEY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72065-8124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-554-6832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3507 MARKETPLACE AVE
-----------------------------------------------------
City | BRYANT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72022-8124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-554-6832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KRISTI LEIGH JONES
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 501-554-6832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------