Provider Demographics
NPI:1386340818
Name:PROSPECTIVELY HEALTHY LLC
Entity type:Organization
Organization Name:PROSPECTIVELY HEALTHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MCHES
Authorized Official - Phone:785-955-9228
Mailing Address - Street 1:209 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3810
Mailing Address - Country:US
Mailing Address - Phone:785-955-9228
Mailing Address - Fax:860-239-8243
Practice Address - Street 1:209 W 12TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3810
Practice Address - Country:US
Practice Address - Phone:785-955-9228
Practice Address - Fax:860-239-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty