Provider Demographics
NPI:1417396797
Name:NEPHROLOGY AND WELLNESS LLC
Entity Type:Organization
Organization Name:NEPHROLOGY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-902-8853
Mailing Address - Street 1:42334 DELUXE PLZ
Mailing Address - Street 2:STE 3
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1237
Mailing Address - Country:US
Mailing Address - Phone:985-902-8853
Mailing Address - Fax:985-902-8854
Practice Address - Street 1:397 HIGHWAY 21
Practice Address - Street 2:STE 601
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3407
Practice Address - Country:US
Practice Address - Phone:985-845-9000
Practice Address - Fax:985-845-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025637207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty