Extracare & Wellness LLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

EXTRACARE & WELLNESS LLC

Practice address

1410 N Pine Hills Rd
Orlando, FL 32808-4408

Phone

(321) 246-5358

NPI assigned

Jul 31, 2019

Last updated

Jul 15, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kettia Cadet Cherenfant, DNPNPI 1851745368

Title

Owner

Phone

(321) 246-5358

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kettia Cadet Cherenfant, NP

  • Primary Care Nurse Practitioner
  • Orlando, FL
  • NPI 1851745368
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1417501040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 N PINE HILLS RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328084408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 N PINE HILLS RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328084408",
            "telephone_number": "321-246-5358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTRACARE & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-31",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "CHERENFANT",
        "authorized_official_first_name": "KETTIA",
        "authorized_official_middle_name": "CADET",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-246-5358",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.