Provider Demographics
NPI:1508617366
Name:BE WELL ADULT, NP, PLLC
Entity Type:Organization
Organization Name:BE WELL ADULT, NP, PLLC
Other - Org Name:ENVISION INTEGRATIVE SERVICES, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING AND CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:CPC,CRC,CPB,CBCS,CMA
Authorized Official - Phone:843-640-9342
Mailing Address - Street 1:1461 LAKELAND AVE UNIT 9
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2174
Mailing Address - Country:US
Mailing Address - Phone:631-467-8224
Mailing Address - Fax:631-585-7575
Practice Address - Street 1:1461 LAKELAND AVE UNIT 9
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2174
Practice Address - Country:US
Practice Address - Phone:631-467-8224
Practice Address - Fax:631-585-7575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BE WELL ADULT, NP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-29
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty