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General NPI Number Information
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NPI Number | 1437022001
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Entity Type | Organization
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Legal Business Name | BLVD WELLNESS, LLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 305 GRETNA BLVD STE A1
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City | GRETNA
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State | LA
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Zip | 70053-4975
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Country | US
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Telephone | 504-388-4680
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Fax | 504-370-4207
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Provider Business Mailing Address
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Address Line | 305 GRETNA BLVD STE A1
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City | GRETNA
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State | LA
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Zip | 70053-4975
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Country | US
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Telephone | 504-388-4680
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Fax | 504-370-4207
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLIN D PITTMAN
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Credential | PMHNP-BC
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Telephone | 504-388-4680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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