Provider Demographics
NPI:1740920123
Name:NPS WITH IVS HYDRATION AND WELLNESS LLC
Entity type:Organization
Organization Name:NPS WITH IVS HYDRATION AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:228-697-4567
Mailing Address - Street 1:13066 SHRINERS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8616
Mailing Address - Country:US
Mailing Address - Phone:228-333-0133
Mailing Address - Fax:228-901-5939
Practice Address - Street 1:13034 SHRINERS BLVD # B
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-8250
Practice Address - Country:US
Practice Address - Phone:228-333-0133
Practice Address - Fax:228-901-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty