Healthcare Provider Details

I. General information

NPI: 1205163490
Provider Name (Legal Business Name): WELLNESS EXPRESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 GUILBEAU RD STE 5D
LAFAYETTE LA
70506-6954
US

IV. Provider business mailing address

312 GUILBEAU RD STE 5D
LAFAYETTE LA
70506-6954
US

V. Phone/Fax

Practice location:
  • Phone: 337-988-1138
  • Fax: 337-984-5037
Mailing address:
  • Phone: 337-988-1138
  • Fax: 337-984-5037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHIRLENE YOUNG MYERS
Title or Position: DIRECTOR
Credential: RN
Phone: 337-988-1138