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General NPI Number Information
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NPI Number | 1851255962
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Entity Type | Organization
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Legal Business Name | IMPACT HEALTH & WELLNESS CLINIC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 270 TRACE COLONY PARK DR STE B
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City | RIDGELAND
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State | MS
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Zip | 39157-8810
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Country | US
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Telephone | 601-236-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 39 TRYSTAN DR
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City | PETAL
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State | MS
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Zip | 39465-2806
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Country | US
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Telephone | 601-236-1800
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | MELISSA WHEATON
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Credential | FNP
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Telephone | 601-236-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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