Provider Demographics
NPI:1073364071
Name:WELLNESS POOLE LLC
Entity Type:Organization
Organization Name:WELLNESS POOLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KALA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-422-6746
Mailing Address - Street 1:104 N SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5104
Mailing Address - Country:US
Mailing Address - Phone:337-516-1770
Mailing Address - Fax:337-516-1887
Practice Address - Street 1:104 N SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5104
Practice Address - Country:US
Practice Address - Phone:337-516-1770
Practice Address - Fax:337-516-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty