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General NPI Number Information
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NPI Number | 1972271245
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Entity Type | Organization
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Legal Business Name | KANOKRAT CLINIC LLC
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 12/11/2021
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Provider Practice Location Address
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Address Line | 211 CAROLINE ST OFC
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-2763
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Country | US
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Telephone | 321-613-2970
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Fax |
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Provider Business Mailing Address
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Address Line | 211 CAROLINE ST OFC
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City | CAPE CANAVERAL
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State | FL
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Zip | 32920-2763
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Country | US
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Telephone | 321-417-1557
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Fax | 321-204-7066
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Authorized Official
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Title or Position | APRN/OWNER
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Name | TEERAPORN WELLS
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Credential |
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Telephone | 321-848-5393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare 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 | 261QC1500X
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Taxonomy Name | Community Health 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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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