| Your Wellness Choice Llc | |
|
1143 Cully Rd Cordova TN 38018-8502 | |
| (901) 672-6410 | |
| (901) 752-8843 |
| Full Name | Your Wellness Choice Llc |
|---|---|
| Speciality | General Practice |
| Location | 1143 Cully Rd, Cordova, Tennessee |
| Authorized Official Name and Position | Imelda Williams (OWNER) |
| Authorized Official Contact | 9016726410 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Wellness Choice Llc 6626 E 75th St Ste 500 Indianapolis IN 46250-2890 Ph: (317) 621-7562 | Your Wellness Choice Llc 1143 Cully Rd Cordova TN 38018-8502 Ph: (901) 672-6410 |
| NPI Number | 1093269334 |
|---|---|
| Provider Enumeration Date | 08/03/2016 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 4284921453 |
|---|---|
| Medicare Enrollment ID | O20161003001624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093269334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Kaye W Borgognoni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366589830 PECOS PAC ID: 4880782234 Enrollment ID: I20071119000132 |
| Provider Name | Melanie Wright |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1447580592 PECOS PAC ID: 9032244595 Enrollment ID: I20100323000280 |
| Provider Name | Sherrie R Serca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518283399 PECOS PAC ID: 5890819148 Enrollment ID: I20100824000645 |
| Provider Name | David T Conner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1639313711 PECOS PAC ID: 2769679901 Enrollment ID: I20101214000422 |
| Provider Name | Jawanner L Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770877623 PECOS PAC ID: 5799953014 Enrollment ID: I20141117000578 |
| Provider Name | Linda Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629468533 PECOS PAC ID: 0042538217 Enrollment ID: I20150420001113 |
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