Provider Demographics
NPI:1629797683
Name:OMNI HEALTH & WELLNESS
Entity Type:Organization
Organization Name:OMNI HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:337-304-8521
Mailing Address - Street 1:804 RODNEY LN
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-0767
Mailing Address - Country:US
Mailing Address - Phone:337-304-8521
Mailing Address - Fax:949-224-7703
Practice Address - Street 1:17 CENTER AVE STE 2
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5536
Practice Address - Country:US
Practice Address - Phone:337-607-5262
Practice Address - Fax:949-224-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty