Organization
KANOKRAT CLINIC LLC
Active
Other names
Kanokrat Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TEERAPORN WELLS (APRN/OWNER)
(321) 848-5393
Entity
Organization
Contact information
Practice address
211 CAROLINE ST OFC, CAPE CANAVERAL, FL 32920-2763
(321) 613-2970
Mailing address
211 CAROLINE ST OFC, CAPE CANAVERAL, FL 32920-2763
(321) 417-1557
(321) 204-7066
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
I DON'T HAVE ONE
—
Enumeration date
09/01/2021
Last updated
12/11/2021
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