PROACTIVE WELLNESS NP – NPI #1124704085
Clinic/Center

PROACTIVE WELLNESS NP is an AHC clinic located in COLUMBIA, MD. NPPES has assigned the NPI number 1124704085 to PROACTIVE WELLNESS NP on June 26, 2023. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “PROACTIVE WELLNESS NP” is a dba name, the actual legal business name for this organization is PROACTIVE WELLNESSNP. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QM1300X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Multi-Specialty

The NPI profile was previously updated about 3 years ago on Dec 06, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for PROACTIVE WELLNESS NP below.

NPI Profile for
PROACTIVE WELLNESSNP

NPI Number
1124704085
Enumeration Date

(about 3 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PROACTIVE WELLNESSNP
Doing Business As (dba): PROACTIVE WELLNESS NP
Primary location
12114 BLUE FLAG WAY
COLUMBIA, MD 21044
Phone: (301) 741-0307 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
KONDI WALTERSSMITH
CEO/ NURSE PRACTITIONER
Phone: (301) 741-0307
Updated
Certification Date
Dec 06, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QM1300X
- Clinic/Center / Multi-Specialty (Primary)
261QR0800X
- Clinic/Center / Recovery Care

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.