Provider Demographics
NPI:1235777418
Name:ASPIRE WELLNESS & FAMILY CLINIC
Entity Type:Organization
Organization Name:ASPIRE WELLNESS & FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREGER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-841-8020
Mailing Address - Street 1:302 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4853
Mailing Address - Country:US
Mailing Address - Phone:662-841-8020
Mailing Address - Fax:662-841-8021
Practice Address - Street 1:302 S SPRING ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4853
Practice Address - Country:US
Practice Address - Phone:662-841-8020
Practice Address - Fax:662-841-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00656791Medicaid