Provider Demographics
NPI:1457814501
Name:CHARIS HEALTH & WELLNESS
Entity Type:Organization
Organization Name:CHARIS HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANISHER
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-692-3157
Mailing Address - Street 1:7500 DOLLARWAY RD STE 403
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-3083
Mailing Address - Country:US
Mailing Address - Phone:870-692-3157
Mailing Address - Fax:870-247-4294
Practice Address - Street 1:7500 DOLLARWAY RD STE 403
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3083
Practice Address - Country:US
Practice Address - Phone:870-718-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANISHER CALDWELL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-06
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty