Provider Demographics
NPI:1154564920
Name:ENHANCED WELLNESS OF OAK GROVE, PLLC
Entity type:Organization
Organization Name:ENHANCED WELLNESS OF OAK GROVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:RYBA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN FNP-BC
Authorized Official - Phone:601-264-7286
Mailing Address - Street 1:56 98 PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8603
Mailing Address - Country:US
Mailing Address - Phone:601-264-7286
Mailing Address - Fax:601-450-4640
Practice Address - Street 1:56 98 PLACE BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8603
Practice Address - Country:US
Practice Address - Phone:601-264-7286
Practice Address - Fax:601-450-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty