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General NPI Number Information
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NPI Number | 1245121995
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Entity Type | Organization
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Legal Business Name | K C WELLNESS LOUNGE LLC
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 4400 W SAMPLE RD STE 112
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3457
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Country | US
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Telephone | 954-546-4378
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 W SAMPLE RD STE 112
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3457
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KERLEINE JESSICA ROSEMEY
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Credential | APRN
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Telephone | 954-464-8592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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