=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255131413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLOW TOTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2025
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4016 HIGHWAY 90 E STE 112
-----------------------------------------------------
City | BROUSSARD
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70518-3548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-761-0808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 WINDY FEATHER DR
-----------------------------------------------------
City | BROUSSARD
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70518-7947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-336-2994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | SHELBI MEYER
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 337-336-2994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------