Provider Demographics
NPI:1063178853
Name:ENM WELLNESS & MORE
Entity type:Organization
Organization Name:ENM WELLNESS & MORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-314-1247
Mailing Address - Street 1:4205 NANEEN DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-3973
Mailing Address - Country:US
Mailing Address - Phone:502-314-1247
Mailing Address - Fax:
Practice Address - Street 1:3438 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2648
Practice Address - Country:US
Practice Address - Phone:502-365-2340
Practice Address - Fax:502-365-3063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENM WELLNESS & MORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK319720OtherMEDICARE
KY7100596910Medicaid