| Divinity Healthcare Services | |
|
611 W 2nd St Homer LA 71040-3221 | |
| (318) 265-4542 | |
| (318) 550-4271 |
| Full Name | Divinity Healthcare Services |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 611 W 2nd St, Homer, Louisiana |
| Authorized Official Name and Position | Ekara Wafer-mendenhall (CEO/ OWNER) |
| Authorized Official Contact | 3182654542 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divinity Healthcare Services 611 W 2nd St Homer LA 71040-3221 Ph: (318) 265-4542 | Divinity Healthcare Services 611 W 2nd St Homer LA 71040-3221 Ph: (318) 265-4542 |
| NPI Number | 1518719483 |
|---|---|
| Provider Enumeration Date | 04/03/2024 |
| Last Update Date | 12/26/2024 |
| Certification Date | 12/26/2024 |
| Medicare PECOS PAC ID | 1850839713 |
|---|---|
| Medicare Enrollment ID | O20240812000034 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518719483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 363LF0000X | Nurse Practitioner - Family | () | Primary |
| Provider Name | Ekara Wafer-mendenhall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811304074 PECOS PAC ID: 3971822305 Enrollment ID: I20150506000216 |
| Provider Name | Kemmerly E Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265189450 PECOS PAC ID: 1153776711 Enrollment ID: I20231017002354 |
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