Provider Demographics
NPI:1104404052
Name:PROSPERITY HEALTH AND WELLNESS PLLC
Entity type:Organization
Organization Name:PROSPERITY HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT GERONTOLOGY NURSE PRACTITIONE
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS-MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:931-249-2502
Mailing Address - Street 1:2608 N MAIN ST STE B-228
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2608 N MAIN ST STE B-228
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1546
Practice Address - Country:US
Practice Address - Phone:931-249-2502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service