Provider Demographics
NPI:1598653552
Name:WESTERN WELLNESS & AESTHETICS LLC
Entity type:Organization
Organization Name:WESTERN WELLNESS & AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, AESTHETIC NURSE
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:REBBECCA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MSN/MHA, RN
Authorized Official - Phone:903-401-9123
Mailing Address - Street 1:2709 COUNTY ROAD 16500
Mailing Address - Street 2:
Mailing Address - City:DEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:75435-5217
Mailing Address - Country:US
Mailing Address - Phone:903-401-9123
Mailing Address - Fax:
Practice Address - Street 1:4510 STONEWALL ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5952
Practice Address - Country:US
Practice Address - Phone:903-401-9123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty