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Organization

PREMIER HEALTH & WELLNESS CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANGIE O WALLER FNP (FNP)
(601) 304-2421
Entity
Organization

Contact information

Practice address
300 HIGHLAND BLVD, SUITE B, NATCHEZ, MS 39120-4600
(601) 304-2421
Mailing address
PO BOX 14149, BATON ROUGE, LA 70898-4149
(225) 930-0060
(225) 952-9075

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
R853759
MS

Other

Enumeration date
10/06/2014
Last updated
03/09/2015
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