Provider Demographics
NPI:1639935042
Name:TOTAL WELLNESS SPECIALIST
Entity Type:Organization
Organization Name:TOTAL WELLNESS SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-202-5410
Mailing Address - Street 1:7317 OLD SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6537
Mailing Address - Country:US
Mailing Address - Phone:662-202-5410
Mailing Address - Fax:
Practice Address - Street 1:116 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2302
Practice Address - Country:US
Practice Address - Phone:662-213-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVIS FAMILY MEDICAL & EXPRESS CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty