Provider Demographics
NPI:1831076819
Name:PREMIER INTEGRATIVE WELLNESS LLC
Entity type:Organization
Organization Name:PREMIER INTEGRATIVE WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-BC, PMHNP-B
Authorized Official - Phone:318-272-4180
Mailing Address - Street 1:839 KINGS HWY STE 125
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4258
Mailing Address - Country:US
Mailing Address - Phone:318-272-4180
Mailing Address - Fax:318-228-2054
Practice Address - Street 1:839 KINGS HWY STE 125
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-4258
Practice Address - Country:US
Practice Address - Phone:318-272-4180
Practice Address - Fax:318-228-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty