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General NPI Number Information
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NPI Number | 1831076819
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Entity Type | Organization
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Legal Business Name | PREMIER INTEGRATIVE WELLNESS LLC
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 839 KINGS HWY STE 125
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City | SHREVEPORT
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State | LA
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Zip | 71104-4258
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Country | US
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Telephone | 318-272-4180
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Fax | 318-228-2054
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Provider Business Mailing Address
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Address Line | 839 KINGS HWY STE 125
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City | SHREVEPORT
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State | LA
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Zip | 71104-4258
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Country | US
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Telephone | 318-272-4180
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Fax | 318-228-2054
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | BRANDI RATLIFF
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Credential | APRN FNP-BC, PMHNP-B
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Telephone | 318-272-4180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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