MEDICARE: OMNIWELLNESS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1780534149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNIWELLNESS

Provider Business Mailing Address
First Line	:	440 MONTICELLO AVE STE 1802
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2670
Country	:	US
Telephone Number	:	804-596-2191
Fax Number	:	804-207-6570

Provider Business Practice Location Address
First Line	:	440 MONTICELLO AVE STE 1802
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2670
Country	:	US
Telephone Number	:	804-596-2191
Fax Number	:	804-207-6570

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	KAYLA COLEMAN
Credential	:	NURSE PRACTITIONER
Telephone Number	:	804-596-2191

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “OMNIWELLNESS ” Practice Location

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