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General NPI Number Information
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NPI Number | 1891369823
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Entity Type | Organization
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Legal Business Name | HOLISTIC WELLNESS GROUP, LLC
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Dates
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Enumeration Date | 05/14/2021
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 808 LAY DAM RD
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City | CLANTON
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State | AL
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Zip | 35045-2943
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Country | US
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Telephone | 205-369-1273
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Fax | 205-369-1273
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Provider Business Mailing Address
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Address Line | 125 COBB DR
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City | JEMISON
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State | AL
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Zip | 35085-4197
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Country | US
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Telephone | 205-430-9966
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Fax | 915-223-1562
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Authorized Official
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Title or Position | PRESCRIBER/MEMBER
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Name | MELISSA ASHLEY
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Credential | CRNP
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Telephone | 205-430-9966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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