# FAMILY WELLNESS PRACTICE LLC

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

## Provider details

- **NPI number:** 1720734841
- **Authorized official:** BRENDA MAHAFFEY APRN, FNP-C (OWNER)
- **Authorized official phone:** (337) 221-2990

## Contact information

- **Practice address:** 411 S PINE ST, DERIDDER, LA 70634-4839
- **Practice address phone:** (337) 462-6070
- **Mailing address:** 411 S PINE ST, DERIDDER, LA 70634-4839
- **Mailing address phone:** (337) 221-2990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/28/2022
- **Last updated:** 08/31/2022