# MIDWEST WOUND & WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215467733
- **Authorized official:** KELLY M ROBERTS FNP (OWNER)
- **Authorized official phone:** (573) 747-1510

## Contact information

- **Practice address:** 555 W PINE ST, FARMINGTON, MO 63640-1439
- **Practice address phone:** (573) 747-1510
- **Practice address fax:** (573) 747-1512
- **Mailing address:** 555 W PINE ST, FARMINGTON, MO 63640-1439
- **Mailing address phone:** (573) 747-1510
- **Mailing address fax:** (573) 747-1512

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 164W00000X | Licensed Practical Nurse | — | NULL | — |
| 164W00000X | Licensed Practical Nurse | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/18/2017
- **Last updated:** 07/21/2022