Organization
WOW FITNESS
Active
Organization
WOW FITNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMEELAH WESLEY (EXECUTIVE DIRECTOR)
(501) 240-2773
Entity
Organization
Contact information
Practice address
5523 MABELVALE PIKE, LITTLE ROCK, AR 72209-1823
(501) 240-2773
Mailing address
5523 MABELVALE PIKE, LITTLE ROCK, AR 72209-1823
(501) 240-2773
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
NETA
AR
174H00000X
Health Educator
Primary
NETA
AR
302R00000X
Health Maintenance Organization
NETA
AR
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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