Provider Demographics
NPI:1730921883
Name:JM WELLNESS & AESTHETICS LLC
Entity type:Organization
Organization Name:JM WELLNESS & AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:STASNEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:817-439-9081
Mailing Address - Street 1:821 SW ALSBURY BLVD UNIT E
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4090
Mailing Address - Country:US
Mailing Address - Phone:817-439-9081
Mailing Address - Fax:817-439-9082
Practice Address - Street 1:821 SW ALSBURY BLVD UNIT E
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4090
Practice Address - Country:US
Practice Address - Phone:817-439-9081
Practice Address - Fax:817-439-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner