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General NPI Number Information
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NPI Number | 1942195797
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Entity Type | Organization
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Legal Business Name | AM WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 1002 MAIN ST
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City | BRIDGEPORT
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State | NE
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Zip | 69336-4035
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Country | US
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Telephone | 308-262-5640
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Fax | 970-667-0847
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Provider Business Mailing Address
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Address Line | PO BOX 147
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City | BRIDGEPORT
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State | NE
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Zip | 69336-0147
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Country | US
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Telephone | 308-262-5640
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Fax | 970-667-0847
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | AMBER MALCOLM
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Credential | NP
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Telephone | 308-778-6468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 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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