| Balanced Life & Wellness Pllc | |
|
1550 Union Rd Ste A Gastonia NC 28054-5522 | |
| (704) 609-5288 | |
| Not Available |
| Full Name | Balanced Life & Wellness Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1550 Union Rd Ste A, Gastonia, North Carolina |
| Authorized Official Name and Position | Desareta Jones (MANAGING MEMBER) |
| Authorized Official Contact | 7046095288 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Balanced Life & Wellness Pllc Po Box 38514 Charlotte NC 28278-1009 Ph: (704) 609-5288 | Balanced Life & Wellness Pllc 1550 Union Rd Ste A Gastonia NC 28054-5522 Ph: (704) 609-5288 |
| NPI Number | 1619722931 |
|---|---|
| Provider Enumeration Date | 04/19/2024 |
| Last Update Date | 02/17/2025 |
| Certification Date | 02/17/2025 |
| Medicare PECOS PAC ID | 2860924172 |
|---|---|
| Medicare Enrollment ID | O20241011000657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619722931 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Desareta Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730891581 PECOS PAC ID: 3779015086 Enrollment ID: I20241011000847 |
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