Provider Demographics
NPI:1043817471
Name:WALLS WELLNESS CENTER
Entity type:Organization
Organization Name:WALLS WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-C
Authorized Official - Phone:304-688-2373
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:VERNER
Mailing Address - State:WV
Mailing Address - Zip Code:25650-0145
Mailing Address - Country:US
Mailing Address - Phone:304-688-2373
Mailing Address - Fax:
Practice Address - Street 1:149 JERRY WEST HWY STE 2A
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3967
Practice Address - Country:US
Practice Address - Phone:304-688-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty