Healthcare Provider Details

I. General information

NPI: 1205727435
Provider Name (Legal Business Name): BEWIGGED HAIR CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 JEFFERSON HWY STE A
JEFFERSON LA
70121-2600
US

IV. Provider business mailing address

245 JEFFER DR
WESTWEGO LA
70094-2100
US

V. Phone/Fax

Practice location:
  • Phone: 504-383-5366
  • Fax: 504-576-0036
Mailing address:
  • Phone: 504-662-8022
  • Fax: 504-576-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN DOLLIS DARBY
Title or Position: OWNER
Credential: COSMETOLOGIST
Phone: 504-383-5366