MEDICARE: TALL PINES WELLNESS

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	:	1891651469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALL PINES WELLNESS

Provider Business Mailing Address
First Line	:	2641 W WHITE MOUNTAIN BLVD
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-6229
Country	:	US
Telephone Number	:	928-300-8295
Fax Number	:

Provider Business Practice Location Address
First Line	:	2641 W WHITE MOUNTAIN BLVD
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-6229
Country	:	US
Telephone Number	:	928-300-8295
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ALENA THOMPSON
Credential	:	NP
Telephone Number	:	928-300-8295

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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Directions to “TALL PINES WELLNESS ” Practice Location

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