# WELGEN ONE OF KENTUCKY LLC

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

## Provider details

- **NPI number:** 1083347827
- **Authorized official:** SHANIRA DELACRUZ (PRESIDENT)
- **Authorized official phone:** (201) 233-2155

## Contact information

- **Practice address:** 629 S 4TH ST STE 301, LOUISVILLE, KY 40202-2461
- **Practice address phone:** (833) 935-4361
- **Mailing address:** 629 S 4TH ST STE 301, LOUISVILLE, KY 40202-2461
- **Mailing address phone:** (833) 935-4361

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 207KI0005X | Clinical & Laboratory Immunology (Allergy & Immunology) Physician | — | NULL | — |
| 207KI0005X | Clinical & Laboratory Immunology (Allergy & Immunology) Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 246YR1600X | Registered Record Administrator | — | NULL | — |
| 246YR1600X | Registered Record Administrator | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/08/2022
- **Last updated:** 11/04/2022