# PROACTIVE WELLNESSNP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Proactive Wellness NP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124704085
- **Authorized official:** KONDI WALTERSSMITH CRNP (CEO/ NURSE PRACTITIONER)
- **Authorized official phone:** (301) 741-0307

## Contact information

- **Practice address:** 12114 BLUE FLAG WAY, COLUMBIA, MD 21044
- **Practice address phone:** (301) 741-0307
- **Mailing address:** 12114 BLUE FLAG WAY, COLUMBIA, MD 21044
- **Mailing address phone:** (301) 741-0307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QR0800X | Recovery Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/26/2023
- **Last updated:** 12/06/2023