Provider Demographics
NPI:1215568217
Name:FRONT PORCH WELLNESS
Entity Type:Organization
Organization Name:FRONT PORCH WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:704-929-9704
Mailing Address - Street 1:307 GARDNER POINT DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28678-8998
Mailing Address - Country:US
Mailing Address - Phone:704-775-3836
Mailing Address - Fax:
Practice Address - Street 1:307 GARDNER POINT DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NC
Practice Address - Zip Code:28678-8998
Practice Address - Country:US
Practice Address - Phone:704-775-3836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty