Provider Demographics
NPI:1689564528
Name:HEALTH AND WEIGHT LOSS AT YOUR DOOR LLC
Entity type:Organization
Organization Name:HEALTH AND WEIGHT LOSS AT YOUR DOOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNE/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC
Authorized Official - Phone:480-974-1912
Mailing Address - Street 1:16165 N 83RD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5816
Mailing Address - Country:US
Mailing Address - Phone:480-974-1912
Mailing Address - Fax:
Practice Address - Street 1:16165 N 83RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5816
Practice Address - Country:US
Practice Address - Phone:480-971-1912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty