Healthcare Provider Details

I. General information

NPI: 1932046950
Provider Name (Legal Business Name): KC HEALING WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 6TH AVE SE
NAPLES FL
34117-4570
US

IV. Provider business mailing address

2841 6TH AVE SE
NAPLES FL
34117-4570
US

V. Phone/Fax

Practice location:
  • Phone: 239-682-5020
  • Fax:
Mailing address:
  • Phone: 239-682-5020
  • Fax:

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: KETTY CHERY
Title or Position: APRN
Credential:
Phone: 239-682-5020