Provider Demographics
NPI:1285394312
Name:WELLCARE GERIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:WELLCARE GERIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMELIMBARAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-645-0105
Mailing Address - Street 1:9119 HIGHWAY 6 STE 230379
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4876
Mailing Address - Country:US
Mailing Address - Phone:979-645-0105
Mailing Address - Fax:
Practice Address - Street 1:9511 PLAZA POINT DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-7244
Practice Address - Country:US
Practice Address - Phone:979-645-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty