Healthcare Provider Details

I. General information

NPI: 1164359394
Provider Name (Legal Business Name): KLA ENTERPRISES, LLC DBA LUXE HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S 6TH ST
MACCLENNY FL
32063-4619
US

IV. Provider business mailing address

1230 S 6TH ST
MACCLENNY FL
32063-4619
US

V. Phone/Fax

Practice location:
  • Phone: 904-651-6585
  • Fax:
Mailing address:
  • Phone: 904-651-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY LYNN ANDREWS AND MAT ANDREWS
Title or Position: APRN, OWNER
Credential: APRN
Phone: 904-651-6585