Provider Demographics
NPI:1639807720
Name:BETTER VIBES LLC
Entity type:Organization
Organization Name:BETTER VIBES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:901-518-9037
Mailing Address - Street 1:1910 MADISON AVE # 3165
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2620
Mailing Address - Country:US
Mailing Address - Phone:901-518-9037
Mailing Address - Fax:
Practice Address - Street 1:1331 UNION AVE
Practice Address - Street 2:SUITE #1226
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-518-9037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ065723Medicaid