Healthcare Provider Details

I. General information

NPI: 1275269946
Provider Name (Legal Business Name): HAVLIK HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CAILLOUET PL STE B
LAFAYETTE LA
70501-7807
US

IV. Provider business mailing address

501 TORRENOVA CIR
LAFAYETTE LA
70508-1834
US

V. Phone/Fax

Practice location:
  • Phone: 337-573-2031
  • Fax: 337-270-2674
Mailing address:
  • Phone: 337-573-2031
  • Fax: 337-270-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA NICOLE HAVLIK
Title or Position: CEO
Credential: FNP
Phone: 337-501-3934