Provider Demographics
NPI:1467132498
Name:INSPIRED SKIN WELLNESS, LLC.
Entity type:Organization
Organization Name:INSPIRED SKIN WELLNESS, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOZER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:254-343-7919
Mailing Address - Street 1:7125 NEW SANGER AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-4054
Mailing Address - Country:US
Mailing Address - Phone:254-343-7919
Mailing Address - Fax:254-459-3711
Practice Address - Street 1:7125 NEW SANGER AVE STE 502
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4054
Practice Address - Country:US
Practice Address - Phone:254-343-7919
Practice Address - Fax:254-459-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty