Blurred Grace LLC
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Kentwood, LA
NPI 1831842244 · NPPES record last updated Jan 27, 2022
Key facts
- NPI
- 1831842244
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- Legal business name
- BLURRED GRACE LLC
- Practice address
- 921 Avenue G
Kentwood, LA 70444-2639 - Phone
- (985) 229-0717
- NPI assigned
- Jan 27, 2022
- Organization subpart
- No
Authorized official
- Name
- Heather Woods, NP
- Title
- Owner
- Phone
- (601) 248-1218
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220310002818 | LA | Part B Supplier - Clinic/Group Practice | 8123413028 |
Receives reassigned benefits from 1 practitioner Practice locations: Kentwood, LA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | Yes |
Addresses
Primary practice location
921 Avenue G
Kentwood, LA 70444-2639
Mailing address
1054 Hawthorne Dr
McComb, MS 39648-9551
Phone (601) 248-1218
Other providers in Kentwood, LA
- 1St Alliance Care Solutions LLC
- Access Health Louisiana
- Franke'a Danay Bergeron
- Bio-Medical Applications of Louisiana, LLC
- Cassandra Denise Braxton
- Braxtons Home Health LLC
- Bridge Builders Consultants, LLC
- Bridge Builders Consultants, LLC
- Brown Morris Pharmacy Inc
All providers in Kentwood, LA · Psychiatric/Mental Health Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.