Healthcare Provider Details

I. General information

NPI: 1487919353
Provider Name (Legal Business Name): LIVING WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70372 5TH ST
COVINGTON LA
70433-5423
US

IV. Provider business mailing address

70372 5TH ST
COVINGTON LA
70433-5423
US

V. Phone/Fax

Practice location:
  • Phone: 504-756-8036
  • Fax: 337-643-8407
Mailing address:
  • Phone: 504-756-8036
  • Fax: 337-643-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP06829
License Number StateLA

VIII. Authorized Official

Name: MS. KELLY ANN ROBINSON
Title or Position: OWNER/NURSE PRACTITIONER
Credential: APRN
Phone: 504-756-8036