Healthcare Provider Details

I. General information

NPI: 1386401123
Provider Name (Legal Business Name): KEWW PRIMARY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CONGRESS PARK DR STE 214
DELRAY BEACH FL
33445-4688
US

IV. Provider business mailing address

200 CONGRESS PARK DR STE 214
DELRAY BEACH FL
33445-4688
US

V. Phone/Fax

Practice location:
  • Phone: 561-758-1205
  • Fax: 561-865-7072
Mailing address:
  • Phone: 561-758-1205
  • Fax: 561-865-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERLA M PIERRE
Title or Position: OWNER
Credential: NP
Phone: 561-758-1205