Healthcare Provider Details

I. General information

NPI: 1407128598
Provider Name (Legal Business Name): FAMILY HEALTH CARE AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 HIGHWAY 190 E
HAMMOND LA
70401-8510
US

IV. Provider business mailing address

2511 HIGHWAY 190 E
HAMMOND LA
70401-8510
US

V. Phone/Fax

Practice location:
  • Phone: 985-543-6800
  • Fax: 985-543-6801
Mailing address:
  • Phone: 985-543-6800
  • Fax: 985-543-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP 04596
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERIE K CODY
Title or Position: OWNER/NP
Credential: FNP-BC
Phone: 985-543-6800