Provider Demographics
NPI:1982303137
Name:EXQUISITE WELLNESS SCREENINGS LLC
Entity Type:Organization
Organization Name:EXQUISITE WELLNESS SCREENINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIERA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-975-7638
Mailing Address - Street 1:11848 S HARRELLS FERRY RD STE E
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2593
Mailing Address - Country:US
Mailing Address - Phone:225-975-7638
Mailing Address - Fax:
Practice Address - Street 1:11848 S HARRELLS FERRY RD STE E
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2593
Practice Address - Country:US
Practice Address - Phone:225-975-7638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory