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General NPI Number Information
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NPI Number | 1770789760
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Entity Type | Organization
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Legal Business Name | KD HEALTH & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 118 JJJ LN
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City | SIMMESPORT
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State | LA
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Zip | 71369-2180
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Country | US
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Telephone | 318-941-5287
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Fax | 318-941-5284
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Provider Business Mailing Address
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Address Line | 118 JJJ LN
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City | SIMMESPORT
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State | LA
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Zip | 71369-2180
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Country | US
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Telephone | 318-941-5287
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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 | DEDRA NEWTON
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Credential | FNP
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Telephone | 225-718-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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