Organization
ETERNITY WELLNESS 22, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAWANA CHANELL RAYMOND FNP-C, PMHNP-BC (NURSE PRACTITIONER, OWNER)
(228) 641-2449
Entity
Organization
Contact information
Practice address
1636 POPPS FERRY RD STE 234, BILOXI, MS 39532-2279
(888) 777-2671
(228) 641-2499
Mailing address
1636 POPPS FERRY RD STE 234, BILOXI, MS 39532-2279
(228) 641-2449
(228) 641-2499
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/19/2021
Last updated
04/18/2024
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