MEDICARE: JM WELLNESS & AESTHETICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1730921883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JM WELLNESS & AESTHETICS LLC

Provider Business Mailing Address
First Line	:	835 SW ALSBURY BLVD UNIT M
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-4094
Country	:	US
Telephone Number	:	817-439-9081
Fax Number	:	817-439-9082

Provider Business Practice Location Address
First Line	:	835 SW ALSBURY BLVD UNIT M
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-4094
Country	:	US
Telephone Number	:	817-439-9081
Fax Number	:	817-439-9082

Authorized Official
Title or Position	:	OWNER
Name	:	MISTY R STASNEY
Credential	:
Telephone Number	:	817-439-9081

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	12/08/2025

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