MEDICARE: WELLNESS POOLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1073364071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS POOLE LLC

Provider Business Mailing Address
First Line	:	211 S MAIN ST
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-5907
Country	:	US
Telephone Number	:	337-516-1770
Fax Number	:	337-516-1887

Provider Business Practice Location Address
First Line	:	211 S MAIN ST
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-5907
Country	:	US
Telephone Number	:	337-516-1770
Fax Number	:	337-516-1887

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	KALA DUHON
Credential	:
Telephone Number	:	337-422-6746

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	05/05/2025

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Directions to “WELLNESS POOLE LLC ” Practice Location

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