Healthcare Provider Details

I. General information

NPI: 1215612122
Provider Name (Legal Business Name): SKP WOUND CARE OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 N AVENUE G STE B
CROWLEY LA
70526-4441
US

IV. Provider business mailing address

814 SW EVANGELINE TRWY STE 509
LAFAYETTE LA
70501-8240
US

V. Phone/Fax

Practice location:
  • Phone: 888-341-5571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEVEN E KRESS
Title or Position: CEO
Credential:
Phone: 615-393-4477