Healthcare Provider Details

I. General information

NPI: 1619913167
Provider Name (Legal Business Name): HEALTHY KIDS, L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 N MAJOR DR
BEAUMONT TX
77706-4060
US

IV. Provider business mailing address

1277 N MAJOR DR
BEAUMONT TX
77706-4060
US

V. Phone/Fax

Practice location:
  • Phone: 409-861-5700
  • Fax: 409-861-5702
Mailing address:
  • Phone: 409-861-5700
  • Fax: 409-861-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JULIE M NGUYEN
Title or Position: PEDIATRIC NURSE PRACTITIONER
Credential: NP
Phone: 409-861-5700