Provider Demographics
NPI:1093530370
Name:K D WELLNESS CENTER LLC
Entity type:Organization
Organization Name:K D WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARNITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:318-564-2330
Mailing Address - Street 1:4830 LINE AVE # 124
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1530
Mailing Address - Country:US
Mailing Address - Phone:318-564-2330
Mailing Address - Fax:
Practice Address - Street 1:4946 NORTHWOOD WEST RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-9278
Practice Address - Country:US
Practice Address - Phone:318-564-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty