# OPTIMAL WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063916195
- **Authorized official:** MRS. SREEDEVI YERRAPRAGADA M.D. (OFFICER/MANAGER)
- **Authorized official phone:** (318) 716-1200

## Contact information

- **Practice address:** 745 OLIVE STREET, SUITE 109, SHREVEPORT, LA 71104
- **Practice address phone:** (318) 716-1200
- **Practice address fax:** (318) 562-3330
- **Mailing address:** 745 OLIVE STREET, SUITE 109, SHREVEPORT, LA 71104
- **Mailing address phone:** (318) 716-1200
- **Mailing address fax:** (318) 562-3330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2018
- **Last updated:** 03/22/2018