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General NPI Number Information
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NPI Number | 1376409748
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Entity Type | Organization
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Legal Business Name | WOUNDLOGIC, LLC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 8143 GOLIAD WAY
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City | BEASLEY
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State | TX
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Zip | 77417
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Country | US
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Telephone | 832-535-1072
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Fax |
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Provider Business Mailing Address
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Address Line | 5614 W GRAND PKWY S STE 102
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City | RICHMOND
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State | TX
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Zip | 77406-5820
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Country | US
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Telephone | 832-535-1072
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KENYAWN SIMMONS
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Credential | FNP
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Telephone | 707-694-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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