Provider Demographics
NPI:1962393025
Name:BASIC WELLNESS PLLC
Entity type:Organization
Organization Name:BASIC WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TITILAYO
Authorized Official - Middle Name:TRACEY
Authorized Official - Last Name:WESTOVER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-875-5221
Mailing Address - Street 1:4 KERRY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1762
Mailing Address - Country:US
Mailing Address - Phone:617-875-5221
Mailing Address - Fax:
Practice Address - Street 1:4 KERRY LN
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1762
Practice Address - Country:US
Practice Address - Phone:617-875-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty