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BALANCED WELLNESS PRIMARY CARE, LLC
NPI 1780926774
Nurse Practitioner - Family in Uncasville, CT

Active since March 18, 2013CLIA 07D2059302 · Waiver
620 NORWICH NEW LONDON TPKE, UNCASVILLE, CT 06382(860) 892-8012(860) 892-8027 Get Directions Write a Review

NPPES record last updated: June 17, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Balanced Wellness Primary Care, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BALANCED WELLNESS PRIMARY CARE, LLC (NPI 1780926774) is a healthcare organization registered as a family in Uncasville, Connecticut and active in the NPI registry since March 2013. The organization holds a CLIA Waiver certificate valid through May 20, 2027 and lists Kristin Marie Mahan, Owner, as its authorized official.

NPPES Registry Identity

NPI1780926774
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameBALANCED WELLNESS PRIMARY CARE, LLC
Location Address620 NORWICH NEW LONDON TPKEUncasville, CT 06382
Mailing Address620 Norwich New London TpkeUncasville, CT 06382 · (860) 892-8012 · Fax (860) 892-8027
Phone(860) 892-8012
Fax(860) 892-8027
Organization SubpartNo
Authorized OfficialKristin Marie MahanOwner · (860) 892-8012
Enumeration DateMarch 18, 2013
Last NPPES UpdateJune 17, 2022
NPPES CertifiedJune 16, 2022
✔ NPI 1780926774 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in CT · 004797
620 NORWICH NEW LONDON TPKE, Uncasville, CT 06382
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 07D2059302

Balanced Wellness Primary Care, LLC · Uncasville, CT
Active · expires May 20, 2027
CLIA Number07D2059302
Laboratory TypePractitioner Other
Certificate Effective DateMay 21, 2025
Certificate Expiration DateMay 20, 2027
Laboratory DirectorKristin M. Mahan Aprn
Laboratory Phone(860) 892-8012
Laboratory LocationBalanced Wellness Primary Care, LLC620 Norwich New London Tpke, Uncasville, CT 06382
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DANIELLE LEE MALLORY APRN FNP-BC
Nurse Practitioner (Family)
620 NORWICH NEW LONDON TPKE
UNCASVILLE, CT 06382
Southeastern Connecticut Planning Region (860) 892-8012
KATHLEEN EAGLE MSN, APRN, FNP-C
Nurse Practitioner (Family)
620 NORWICH NEW LONDON TPKE
UNCASVILLE, CT 06382
Southeastern Connecticut Planning Region (860) 892-8012
DALEO LIU PLLC
Dentist (General Practice)
620 NORWICH NEW LONDON TPKE
UNCASVILLE, CT 06382
Southeastern Connecticut Planning Region (860) 848-1291
DR. ELIZABETH KOZLOWSKI DMD
Dentist (General Practice)
620 NORWICH NEW LONDON TPKE
UNCASVILLE, CT 06382
Southeastern Connecticut Planning Region (860) 848-2364
DR. JAMES JOSEPH DALEO JR. D.D.S.
Dentist (General Practice)
620 NORWICH NEW LONDON TPKE
UNCASVILLE, CT 06382
Southeastern Connecticut Planning Region (860) 848-1291
JESSICA VAN RYE APRN FNP BC LLC
Nurse Practitioner (Family)
620 NORWICH NEW LONDON TPKE
UNCASVILLE, CT 06382
Southeastern Connecticut Planning Region (860) 892-8012
KRISTIN MARIE MAHAN
Nurse Practitioner (Family)
620 NORWICH NEW LONDON TPKE
UNCASVILLE, CT 06382
Southeastern Connecticut Planning Region (860) 892-8012
DR. MARK ALOYSIUS KOZLOWSKI D.M.D.
Dentist (General Practice)
620 NORWICH NEW LONDON TPKE
UNCASVILLE, CT 06382
Southeastern Connecticut Planning Region (860) 848-1291

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Balanced Wellness Primary Care, LLC's NPI number?

The NPI number for Balanced Wellness Primary Care, LLC is 1780926774. It was assigned to this organization in the NPPES registry on March 18, 2013.

Where is Balanced Wellness Primary Care, LLC located?

Balanced Wellness Primary Care, LLC is located at 620 Norwich New London Tpke, Uncasville, CT 06382. The listed phone number is (860) 892-8012.

What is Balanced Wellness Primary Care, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Balanced Wellness Primary Care, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 07D2059302) is associated with this NPI, valid through May 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Balanced Wellness Primary Care, LLC was last updated on June 17, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.