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General NPI Number Information
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NPI Number | 1841932563
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Entity Type | Organization
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Legal Business Name | ESSENTIAL WELLCARE
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 02/19/2023
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Provider Practice Location Address
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Address Line | 3419 NW EVANGELINE TRWY STE D3
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City | CARENCRO
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State | LA
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Zip | 70520-6241
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Country | US
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Telephone | 225-341-2791
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1057
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City | CARENCRO
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State | LA
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Zip | 70520-1057
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Country | US
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Telephone | 337-565-9320
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. SHERELLE SION PICKNEY
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Credential | FNP-BC
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Telephone | 225-341-2791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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