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JOMON WELLNESS LLC
NPI 1922853860
Nurse Practitioner - Family in Stanford, KY

Active since April 23, 2024CLIA 18D2312448 · Waiver
132 FRONTIER BLVD STE 103, STANFORD, KY 40484(859) 287-2949(855) 297-6367 Get Directions Write a Review

NPPES record last updated: November 20, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 20, 2025, Apr 23, 2024 (2 updates tracked since 2024).

About Jomon Wellness Llc NPPES

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

JOMON WELLNESS LLC (NPI 1922853860) is a healthcare organization registered as a family in Stanford, Kentucky and active in the NPI registry since April 2024. The organization holds a CLIA Waiver certificate valid through October 10, 2026 and lists Tracy Boller, Owner/np, as its authorized official.

NPPES Registry Identity

NPI1922853860
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameJOMON WELLNESS LLC
Location Address132 FRONTIER BLVD STE 103Stanford, KY 40484-6516
Mailing Address132 Frontier Blvd Ste 103Stanford, KY 40484-6516 · (859) 287-2949 · Fax (855) 297-6367
Phone(859) 287-2949
Fax(855) 297-6367
Organization SubpartNo
Authorized OfficialTracy BollerOwner/np · (859) 287-2949
Enumeration DateApril 23, 2024
Last NPPES UpdateNovember 20, 20252 updates tracked since enumeration
NPPES CertifiedNovember 20, 2025
✔ NPI 1922853860 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
132 FRONTIER BLVD STE 103, Stanford, KY 40484
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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 18D2312448

Jomon Wellness LLC · Stanford, KY
Active · expires Oct 10, 2026
CLIA Number18D2312448
Laboratory TypePhysician Office
Certificate Effective DateOctober 11, 2024
Certificate Expiration DateOctober 10, 2026
Laboratory DirectorMs. Tracy M. Boller
Laboratory Phone(859) 287-2949
Laboratory LocationJomon Wellness LLC132 Frontier Blvd Suite 103, Stanford, KY 40484
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

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

MRS. TRACY MICHELE BOLLER APRN
Nurse Practitioner (Family)
132 FRONTIER BLVD STE 103
STANFORD, KY 40484
Lincoln County (859) 287-2949

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 Jomon Wellness LLC's NPI number?

The NPI number for Jomon Wellness LLC is 1922853860. It was assigned to this organization in the NPPES registry on April 23, 2024.

Where is Jomon Wellness LLC located?

Jomon Wellness LLC is located at 132 Frontier Blvd Ste 103, Stanford, KY 40484. The listed phone number is (859) 287-2949.

What is Jomon Wellness LLC's specialty?

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

Does Jomon Wellness LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D2312448) is associated with this NPI, valid through October 10, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jomon Wellness LLC was last updated on November 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months 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.