| Optimal Health And Wellness Clinic, Pllc | |
|
1700 University Blvd Ste 8 Jackson MS 39204-3907 | |
| (601) 502-4245 | |
| Not Available |
| Full Name | Optimal Health And Wellness Clinic, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1700 University Blvd Ste 8, Jackson, Mississippi |
| Authorized Official Name and Position | Mackinzie Lee (NURSE PRACTITIONER) |
| Authorized Official Contact | 6015024245 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Health And Wellness Clinic, Pllc 4985 Springridge Rd Raymond MS 39154-9492 Ph: (601) 502-4245 | Optimal Health And Wellness Clinic, Pllc 1700 University Blvd Ste 8 Jackson MS 39204-3907 Ph: (601) 502-4245 |
| NPI Number | 1568100923 |
|---|---|
| Provider Enumeration Date | 05/25/2022 |
| Last Update Date | 05/25/2022 |
| Medicare PECOS PAC ID | 5991173536 |
|---|---|
| Medicare Enrollment ID | O20221201002167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568100923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Mackinzie Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982292926 PECOS PAC ID: 5991171837 Enrollment ID: I20221019000032 |
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