Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Proactive Wellnessnp

Organization Multi-Specialty Clinic/Center · NPI 1124704085

Proactive Wellnessnp is a Multi-Specialty Clinic/Center in Columbia, Maryland. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
2

Practice location Address checks out

12114 Blue Flag Way
Columbia, MD 21044
Phone: (301) 741-0307
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Multi-Specialty Clinic/Center (primary) Taxonomy 261QM1300X
Recovery Care Clinic/Center Taxonomy 261QR0800X

Record details

NPI number1124704085
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kondi Walterssmith — Ceo/ Nurse Practitioner · (301) 741-0307
Other names Proactive Wellness Np; Proactive Wellness Np
NPI enumeratedJune 26, 2023
Last updated in NPPESDecember 6, 2023
Certification dateDecember 6, 2023
Mailing address12114 Blue Flag Way, Columbia, MD 21044

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