| Foundation: A Wellness Practice, Llc | |
|
533 W Washington Ave Jonesboro AR 72401 | |
| (870) 229-0302 | |
| (870) 520-6482 |
| Full Name | Foundation: A Wellness Practice, Llc |
|---|---|
| Speciality | Counselor |
| Location | 533 W Washington Ave, Jonesboro, Arkansas |
| Authorized Official Name and Position | Vicki Lanell White (OWNER) |
| Authorized Official Contact | 5733440976 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Foundation: A Wellness Practice, Llc 533 W Washington Ave Jonesboro AR 72401-2782 Ph: (870) 229-0302 | Foundation: A Wellness Practice, Llc 533 W Washington Ave Jonesboro AR 72401 Ph: (870) 229-0302 |
| NPI Number | 1750878203 |
|---|---|
| Provider Enumeration Date | 04/20/2018 |
| Last Update Date | 09/28/2018 |
| Medicare PECOS PAC ID | 2668718172 |
|---|---|
| Medicare Enrollment ID | O20190103002743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750878203 | NPI | - | NPPES |
| Provider Name | Angie D Hicks-master |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255405353 PECOS PAC ID: 5496858110 Enrollment ID: I20070316000197 |
| Provider Name | Stacy A Emerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942508999 PECOS PAC ID: 4880870757 Enrollment ID: I20110511000346 |
| Provider Name | Vickie L White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134248164 PECOS PAC ID: 4284881962 Enrollment ID: I20120912000108 |
| Provider Name | Lauren E Hannah |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730330473 PECOS PAC ID: 1658693692 Enrollment ID: I20141203000281 |
| Provider Name | Amy J Inman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639427099 PECOS PAC ID: 8426319716 Enrollment ID: I20180501000207 |
| Provider Name | Kenya Duncan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720538069 PECOS PAC ID: 7113350935 Enrollment ID: I20191210001257 |
| Provider Name | Aaron G Hannah |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033472964 PECOS PAC ID: 7719302363 Enrollment ID: I20200730001147 |
| Provider Name | Angela St Pierre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689176836 PECOS PAC ID: 9537576244 Enrollment ID: I20210325000261 |
| Provider Name | Sarah Taylor Lipsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609423292 PECOS PAC ID: 1658754510 Enrollment ID: I20220810002793 |
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