Organization
INDIANOLA WELLNESS CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAJUANDRA K CHANDLER NP (MANAGER/OWNER)
(662) 303-3743
Entity
Organization
Contact information
Practice address
131 MAIN ST, INDIANOLA, MS 38751-2849
(662) 303-3743
Mailing address
108 WHITTINGTON DR, INDIANOLA, MS 38751-3434
(662) 303-3743
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
901379
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03321871
—
MS
Enumeration date
05/15/2017
Last updated
06/16/2018
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