Provider Demographics
NPI:1659160745
Name:MEDWELL PLUS, LLC
Entity type:Organization
Organization Name:MEDWELL PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:662-720-6007
Mailing Address - Street 1:1204C N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-1013
Mailing Address - Country:US
Mailing Address - Phone:662-720-6007
Mailing Address - Fax:662-966-0007
Practice Address - Street 1:1204C N 2ND ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-1013
Practice Address - Country:US
Practice Address - Phone:662-720-6007
Practice Address - Fax:662-966-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty