Provider Demographics
NPI:1295563880
Name:TRANSFORMATIVE HEALTH AND WELLNESS, PLLC
Entity type:Organization
Organization Name:TRANSFORMATIVE HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KIERA
Authorized Official - Middle Name:RU'SHELLE
Authorized Official - Last Name:SLADE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:336-514-3587
Mailing Address - Street 1:900 E SIX FORKS RD UNIT 522
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1843
Mailing Address - Country:US
Mailing Address - Phone:336-514-3587
Mailing Address - Fax:
Practice Address - Street 1:900 E SIX FORKS RD UNIT 522
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1843
Practice Address - Country:US
Practice Address - Phone:336-514-3587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty