=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851048037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUSTED HEALTH AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2022
-----------------------------------------------------
Last Update Date | 07/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 S MAIN ST
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71852-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-455-0256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 899 MARTIN LUTHER KING JR DR
-----------------------------------------------------
City | MINERAL SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71851-9044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-703-3034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | SHARONDA MILLER
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 870-703-3034
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------