# PWWL CENTERS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Physician's Wellness & Weight Loss
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154198737
- **Authorized official:** JERRY DALE FREDERIKSEN SR. (MANAGING MEMBER)
- **Authorized official phone:** (479) 459-6354

## Contact information

- **Practice address:** 644 STATELINE RD, COLCORD, OK 74338-1344
- **Practice address phone:** (918) 203-0004
- **Mailing address:** PO BOX 6691, VAN BUREN, AR 72956-0601
- **Mailing address phone:** (479) 459-6354

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/05/2023
- **Last updated:** 12/05/2023