Healthcare Provider Details

I. General information

NPI: 1245121995
Provider Name (Legal Business Name): K C WELLNESS LOUNGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W SAMPLE RD STE 112
COCONUT CREEK FL
33073-3457
US

IV. Provider business mailing address

4400 W SAMPLE RD STE 112
COCONUT CREEK FL
33073-3457
US

V. Phone/Fax

Practice location:
  • Phone: 954-546-4378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KERLEINE JESSICA ROSEMEY
Title or Position: MANAGING MEMBER
Credential: APRN
Phone: 954-464-8592