Provider Demographics
NPI:1386401123
Name:KEWW PRIMARY CARE CENTER LLC
Entity type:Organization
Organization Name:KEWW PRIMARY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:561-758-1205
Mailing Address - Street 1:200 CONGRESS PARK DR STE 214
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4688
Mailing Address - Country:US
Mailing Address - Phone:561-758-1205
Mailing Address - Fax:561-865-7072
Practice Address - Street 1:200 CONGRESS PARK DR STE 214
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4688
Practice Address - Country:US
Practice Address - Phone:561-758-1205
Practice Address - Fax:561-865-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty