Provider Demographics
NPI:1639889454
Name:VILLAGE KIDZ WIC CLINIC
Entity Type:Organization
Organization Name:VILLAGE KIDZ WIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:CHRISTY
Authorized Official - Last Name:HONORE'
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN-BC, FNP-BC
Authorized Official - Phone:225-200-6200
Mailing Address - Street 1:4085 FLORIDA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3858
Mailing Address - Country:US
Mailing Address - Phone:225-200-6200
Mailing Address - Fax:225-465-5651
Practice Address - Street 1:4085 FLORIDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3858
Practice Address - Country:US
Practice Address - Phone:225-200-6200
Practice Address - Fax:225-465-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty