Provider Demographics
NPI:1942049697
Name:BREATHE & BALANCE PLLC
Entity type:Organization
Organization Name:BREATHE & BALANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, FNP-BC, PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP, PMHNP
Authorized Official - Phone:870-530-4440
Mailing Address - Street 1:3938 COUNTY ROAD 757
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8251
Mailing Address - Country:US
Mailing Address - Phone:870-530-4440
Mailing Address - Fax:
Practice Address - Street 1:3938 COUNTY ROAD 757
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-8251
Practice Address - Country:US
Practice Address - Phone:870-301-2740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR324043762Medicaid