Provider Demographics
NPI:1891499497
Name:VITALITY WELLNESS LLC
Entity Type:Organization
Organization Name:VITALITY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-562-3390
Mailing Address - Street 1:8707 SPRING CYPRESS RD STE E
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3331
Mailing Address - Country:US
Mailing Address - Phone:832-562-3390
Mailing Address - Fax:832-562-3391
Practice Address - Street 1:8707 SPRING CYPRESS RD STE E
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3331
Practice Address - Country:US
Practice Address - Phone:832-562-3390
Practice Address - Fax:832-562-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty