Healthcare Provider Details

I. General information

NPI: 1205000304
Provider Name (Legal Business Name): THE CLINIC OF WELSH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 HIGHWAY 90
ROANOKE LA
70581-3505
US

IV. Provider business mailing address

7533 HIGHWAY 90
ROANOKE LA
70581-3505
US

V. Phone/Fax

Practice location:
  • Phone: 337-753-2579
  • Fax: 337-753-2468
Mailing address:
  • Phone: 337-734-4500
  • Fax: 337-734-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberRN066886
License Number StateLA

VIII. Authorized Official

Name: YVONNE HEBERT KRIELOW
Title or Position: NURSE PRACTITIONER
Credential: A.P.R.N., B.C.
Phone: 337-734-4500