Provider Demographics
NPI:1104471747
Name:TOTAL HEALTH AND WELLNESS, PLLC
Entity type:Organization
Organization Name:TOTAL HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BISONA
Authorized Official - Middle Name:YEBA
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:210-219-1160
Mailing Address - Street 1:120 HELMWOOD PLAZA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3458
Mailing Address - Country:US
Mailing Address - Phone:270-600-7001
Mailing Address - Fax:
Practice Address - Street 1:120 HELMWOOD PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3458
Practice Address - Country:US
Practice Address - Phone:270-600-7001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty