Organization · Type 2 NPI
Providence Wellness, LLC
Psychiatric/Mental Health Nurse Practitioner · Pearl, MS
NPI number
1548076490
Active
Practice location
4490 Highway 80 E Ste A
Pearl, MS 39208-4206
Fax (240) 219-3126
Mailing address
206 Grand Oak Blvd
Clinton, MS 39056-6040
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner | 363LF0000X | None listed |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | None listed |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
2 other providers at this address
About NPI 1548076490
Providence Wellness, LLC's National Provider Identifier is 1548076490, issued on Dec 5, 2024. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Pearl, MS. The record was last updated on Apr 22, 2025.