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General NPI Number Information
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NPI Number | 1841134533
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Entity Type | Organization
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Legal Business Name | BLOOM WELL HEALTH CLINIC LLC
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Dates
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Enumeration Date | 04/15/2026
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 2667 BATTEN HILL RD
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City | BLACKSHEAR
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State | GA
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Zip | 31516-4938
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Country | US
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Telephone | 912-282-2025
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Fax |
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Provider Business Mailing Address
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Address Line | 2667 BATTEN HILL RD
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City | BLACKSHEAR
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State | GA
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Zip | 31516-4938
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Country | US
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Telephone | 912-282-2025
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LISA ANN BATTEN
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Credential | DNP, NP-C
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Telephone | 912-282-2025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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