Provider Demographics
NPI:1497446769
Name:STILL WATERS WELLNESS LLC
Entity Type:Organization
Organization Name:STILL WATERS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-613-2354
Mailing Address - Street 1:301 S MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72521-5010
Mailing Address - Country:US
Mailing Address - Phone:870-613-2354
Mailing Address - Fax:
Practice Address - Street 1:301 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:AR
Practice Address - Zip Code:72521-5010
Practice Address - Country:US
Practice Address - Phone:870-613-2354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty