Healthcare Provider Details

I. General information

NPI: 1952246803
Provider Name (Legal Business Name): VILLAGE AESTHETICS CORP DBA VILLAGE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7659 GILBERT ST STE D
GILBERT LA
71336-3410
US

IV. Provider business mailing address

7659 GILBERT ST STE D
GILBERT LA
71336-3410
US

V. Phone/Fax

Practice location:
  • Phone: 318-657-1220
  • Fax:
Mailing address:
  • Phone: 318-657-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEXI PENICK
Title or Position: MANAGER
Credential:
Phone: 318-657-1220