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General NPI Number Information
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NPI Number | 1952737124
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Entity Type | Organization
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Legal Business Name | PATHWAY TO WELLNESS, LLC
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 5839 PEAR ORCHARD RD
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City | JACKSON
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State | MS
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Zip | 39211-3311
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Country | US
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Telephone | 769-572-4286
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Fax |
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Provider Business Mailing Address
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Address Line | 5839 PEAR ORCHARD RD
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City | JACKSON
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State | MS
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Zip | 39211-3311
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Country | US
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Telephone | 769-572-4286
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. GETTY E ISRAEL
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Credential | M.PH
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Telephone | 769-572-4286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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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 | 174H00000X
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Taxonomy Name | Health Educator
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 12329
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License Number State | MS
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Taxonomy #5
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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