Provider Demographics
NPI:1841932563
Name:ESSENTIAL WELLCARE
Entity type:Organization
Organization Name:ESSENTIAL WELLCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERELLE
Authorized Official - Middle Name:SION
Authorized Official - Last Name:PICKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:225-341-2791
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-1057
Mailing Address - Country:US
Mailing Address - Phone:337-565-9320
Mailing Address - Fax:
Practice Address - Street 1:3419 NW EVANGELINE TRWY STE D3
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-6241
Practice Address - Country:US
Practice Address - Phone:225-341-2791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251J00000XAgenciesNursing Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory