MEDICARE: COUNTERMEASURE 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1972367480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTERMEASURE WELLNESS

Provider Business Mailing Address
First Line	:	12119 CANAL DR
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5334
Country	:	US
Telephone Number	:	502-667-0364
Fax Number	:

Provider Business Practice Location Address
First Line	:	12119 CANAL DR
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5334
Country	:	US
Telephone Number	:	502-667-0364
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAITLYN BARNETT
Credential	:	FNP
Telephone Number	:	502-667-0364

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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Directions to “COUNTERMEASURE WELLNESS ” Practice Location

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