Provider Demographics
NPI:1962236927
Name:WELLNESS 41, LLC
Entity type:Organization
Organization Name:WELLNESS 41, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:620-727-7831
Mailing Address - Street 1:12114 W JEWELL ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-4104
Mailing Address - Country:US
Mailing Address - Phone:620-727-7831
Mailing Address - Fax:
Practice Address - Street 1:10209 W CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4685
Practice Address - Country:US
Practice Address - Phone:620-727-7831
Practice Address - Fax:316-330-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty