Healthcare Provider Details

I. General information

NPI: 1629797683
Provider Name (Legal Business Name): OMNI HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CENTER AVE STE 2
SULPHUR LA
70663-5536
US

IV. Provider business mailing address

804 RODNEY LN
SULPHUR LA
70663-0767
US

V. Phone/Fax

Practice location:
  • Phone: 337-607-5262
  • Fax: 949-224-7703
Mailing address:
  • Phone: 337-304-8521
  • Fax: 949-224-7703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAYLA GASPARD
Title or Position: OWNER/PROVIDER
Credential: NP
Phone: 337-304-8521