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General NPI Number Information
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NPI Number | 1811449317
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Entity Type | Organization
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Legal Business Name | KWP HEALTHCARE, LLC
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 421 S VELASCO ST
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City | ANGLETON
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State | TX
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Zip | 77515-6015
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Country | US
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Telephone | 979-848-1886
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Fax | 979-848-1376
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Provider Business Mailing Address
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Address Line | 421 S VELASCO ST
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City | ANGLETON
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State | TX
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Zip | 77515-6015
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Country | US
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Telephone | 979-848-1886
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEITH PESNELL
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Credential | PT
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Telephone | 979-848-1886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | TX
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