| Desoto Family Wellness Center, Llc | |
|
3495 Cobblestone Blvd S Southaven MS 38672-7075 | |
| (662) 892-2885 | |
| (662) 892-2889 |
| Full Name | Desoto Family Wellness Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3495 Cobblestone Blvd S, Southaven, Mississippi |
| Authorized Official Name and Position | Amy Lynn Ollar (OFFICE MANAGER) |
| Authorized Official Contact | 6628922885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desoto Family Wellness Center, Llc 3495 Cobblestone Blvd S Southaven MS 38672-7075 Ph: (662) 892-2885 | Desoto Family Wellness Center, Llc 3495 Cobblestone Blvd S Southaven MS 38672-7075 Ph: (662) 892-2885 |
| NPI Number | 1376143024 |
|---|---|
| Provider Enumeration Date | 10/30/2020 |
| Last Update Date | 09/18/2023 |
| Certification Date | 09/18/2023 |
| Medicare PECOS PAC ID | 2264845973 |
|---|---|
| Medicare Enrollment ID | O20210119000425 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376143024 | NPI | - | NPPES |
| Provider Name | Amanda S Savage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871865717 PECOS PAC ID: 5890955132 Enrollment ID: I20120326000022 |
| Provider Name | Jennifer B. Warren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174872626 PECOS PAC ID: 9133378748 Enrollment ID: I20120925000526 |
| Provider Name | Ginger Lee Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275936163 PECOS PAC ID: 9335461359 Enrollment ID: I20141202002293 |
| Provider Name | Susan Elyse Mccullough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518583129 PECOS PAC ID: 4880007509 Enrollment ID: I20210119000981 |
| Provider Name | Dana Faith Gilbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992423602 PECOS PAC ID: 5799169959 Enrollment ID: I20220907002454 |
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