| Wholelife Family Wellness Clinic Of Providence Pllc | |
|
169 N Gateway Dr. Suite 170 Providence UT 84332 | |
| (435) 213-3597 | |
| Not Available |
| Full Name | Wholelife Family Wellness Clinic Of Providence Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 169 N Gateway Dr. Suite 170, Providence, Utah |
| Authorized Official Name and Position | Natalie Jean Gibson (CO-OWNER) |
| Authorized Official Contact | 4352133597 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wholelife Family Wellness Clinic Of Providence Pllc 274 N Main St Logan UT 84321-3915 Ph: (435) 753-1600 | Wholelife Family Wellness Clinic Of Providence Pllc 169 N Gateway Dr. Suite 170 Providence UT 84332 Ph: (435) 213-3597 |
| NPI Number | 1962049932 |
|---|---|
| Provider Enumeration Date | 12/09/2019 |
| Last Update Date | 03/13/2020 |
| Certification Date | 03/13/2020 |
| Medicare PECOS PAC ID | 5193153294 |
|---|---|
| Medicare Enrollment ID | O20200324003049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962049932 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Kaye Marie Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922491430 PECOS PAC ID: 1153642285 Enrollment ID: I20150602000676 |
| Provider Name | Natalie J Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528419330 PECOS PAC ID: 9739477928 Enrollment ID: I20161004000013 |
| Provider Name | Kellie Ann Nielsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992154777 PECOS PAC ID: 3779863543 Enrollment ID: I20180724002474 |
| Provider Name | Stephanie M Sampson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215596192 PECOS PAC ID: 3779915798 Enrollment ID: I20191113001636 |
| Provider Name | Whitney Michelle Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356758759 PECOS PAC ID: 1850708371 Enrollment ID: I20210330001821 |
| Provider Name | Emily J. Rhodes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558017095 PECOS PAC ID: 0840655973 Enrollment ID: I20230425001695 |
| Provider Name | Schon Thomas Knowles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023797081 PECOS PAC ID: 3870948615 Enrollment ID: I20231013000706 |
| Provider Name | Andrea Gayle Simons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609655927 PECOS PAC ID: 8527418821 Enrollment ID: I20231228003678 |
Ty B. Aller, Lmft, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 545 W 465 N Ste 130, Providence, UT 84332 Phone: 385-200-3993 | |
Kent W Anderson Phd Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 545 W 465 N, Suite 130, Providence, UT 84332 Phone: 435-752-7627 Fax: 435-752-7802 | |
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