Provider Demographics
NPI:1952049272
Name:KB BODY SLUTIONS LLC
Entity Type:Organization
Organization Name:KB BODY SLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KELECHI
Authorized Official - Middle Name:EKE
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:612-235-9988
Mailing Address - Street 1:8981 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2174
Mailing Address - Country:US
Mailing Address - Phone:469-954-4789
Mailing Address - Fax:
Practice Address - Street 1:2640 W UNIVERSITY DR STE 1266
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1609
Practice Address - Country:US
Practice Address - Phone:469-954-4789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty