Provider Demographics
NPI:1477267946
Name:HEALING JOURNEY HEALTH & WELLNESS PLLC
Entity Type:Organization
Organization Name:HEALING JOURNEY HEALTH & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-900-4549
Mailing Address - Street 1:719 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5421
Mailing Address - Country:US
Mailing Address - Phone:501-900-4549
Mailing Address - Fax:501-499-6234
Practice Address - Street 1:719 FRONT ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5421
Practice Address - Country:US
Practice Address - Phone:501-900-4549
Practice Address - Fax:501-499-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty