Provider Demographics
NPI:1851180046
Name:A1 INTEGRATED WELLNESS, LLC
Entity type:Organization
Organization Name:A1 INTEGRATED WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JYLLA
Authorized Official - Middle Name:DEANE
Authorized Official - Last Name:ARTIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-226-0748
Mailing Address - Street 1:526 S CONKLING ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4201
Mailing Address - Country:US
Mailing Address - Phone:240-433-3557
Mailing Address - Fax:463-362-2504
Practice Address - Street 1:526 S CONKLING ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4201
Practice Address - Country:US
Practice Address - Phone:240-433-3557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty