Healthcare Provider Details

I. General information

NPI: 1245013432
Provider Name (Legal Business Name): CHERISHED SOLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 JEROLD DR
WEST MONROE LA
71291-9718
US

IV. Provider business mailing address

116 JEROLD DR
WEST MONROE LA
71291-9718
US

V. Phone/Fax

Practice location:
  • Phone: 318-235-2875
  • Fax:
Mailing address:
  • Phone: 318-235-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KATELANN POWELL
Title or Position: OWNER
Credential: MSN, RN
Phone: 318-235-2875