Provider Demographics
NPI:1497008692
Name:QO WELLNESS PC
Entity type:Organization
Organization Name:QO WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORPURT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:865-548-1606
Mailing Address - Street 1:12744 KINGSTON PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0940
Mailing Address - Country:US
Mailing Address - Phone:865-274-7663
Mailing Address - Fax:
Practice Address - Street 1:12744 KINGSTON PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-0940
Practice Address - Country:US
Practice Address - Phone:865-274-7663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN413612084P0800X
TNLSW35771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty