Provider Demographics
NPI:1497526198
Name:ALIVE & WELL LLC
Entity Type:Organization
Organization Name:ALIVE & WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-216-2212
Mailing Address - Street 1:908 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1532
Mailing Address - Country:US
Mailing Address - Phone:270-216-2212
Mailing Address - Fax:270-297-8311
Practice Address - Street 1:110 W MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1202
Practice Address - Country:US
Practice Address - Phone:270-216-2212
Practice Address - Fax:270-297-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty