Healthcare Provider Details

I. General information

NPI: 1639889454
Provider Name (Legal Business Name): VILLAGE KIDZ WIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4085 FLORIDA BLVD STE A
BATON ROUGE LA
70806-3858
US

IV. Provider business mailing address

4085 FLORIDA BLVD STE A
BATON ROUGE LA
70806-3858
US

V. Phone/Fax

Practice location:
  • Phone: 225-200-6200
  • Fax: 225-465-5651
Mailing address:
  • Phone: 225-964-5332
  • Fax: 225-465-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. NIKKI CHRISTY HONORE'
Title or Position: OWNER/DIRECTOR
Credential: DNP, APRN-BC, FNP-BC
Phone: 225-964-5332