Provider Demographics
NPI:1215622972
Name:COMMUNITY WELLNESS GROUP LLC
Entity type:Organization
Organization Name:COMMUNITY WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KIARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:601-669-7357
Mailing Address - Street 1:332 E MONTICELLO ST
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3430
Mailing Address - Country:US
Mailing Address - Phone:601-669-7357
Mailing Address - Fax:
Practice Address - Street 1:332 E MONTICELLO ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3430
Practice Address - Country:US
Practice Address - Phone:601-669-7357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty