Provider Demographics
NPI:1053022988
Name:EMPIRICAL WELLNESS CENTER
Entity type:Organization
Organization Name:EMPIRICAL WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:336-266-0334
Mailing Address - Street 1:1610 VAUGHN RD STE H
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2919
Mailing Address - Country:US
Mailing Address - Phone:336-567-4033
Mailing Address - Fax:800-418-5873
Practice Address - Street 1:3729 S CHURCH ST STE 102
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-0050
Practice Address - Country:US
Practice Address - Phone:336-266-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty