| Deepblue Wellness Llc | |
|
4421 Conlin St Ste 101 Metairie LA 70006-2145 | |
| (337) 643-8424 | |
| (337) 643-8407 |
| Full Name | Deepblue Wellness Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4421 Conlin St Ste 101, Metairie, Louisiana |
| Authorized Official Name and Position | Nicolas Vergara (OWNER) |
| Authorized Official Contact | 5042754489 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deepblue Wellness Llc Po Box 85 Kaplan LA 70548-0085 Ph: (337) 643-8424 | Deepblue Wellness Llc 4421 Conlin St Ste 101 Metairie LA 70006-2145 Ph: (337) 643-8424 |
| NPI Number | 1518460211 |
|---|---|
| Provider Enumeration Date | 03/09/2018 |
| Last Update Date | 03/09/2018 |
| Medicare PECOS PAC ID | 5092078089 |
|---|---|
| Medicare Enrollment ID | O20180404000293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518460211 | NPI | - | NPPES |
| 1507814 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | MD.204964 (Louisiana) | Primary |
| Provider Name | Nicolas Vergara |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003084625 PECOS PAC ID: 7012170301 Enrollment ID: I20120524000204 |
| Provider Name | Shanta Marie Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427468503 PECOS PAC ID: 9436379922 Enrollment ID: I20141006000376 |
| Provider Name | Amanda S Eymard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790162626 PECOS PAC ID: 7214241850 Enrollment ID: I20150727002505 |
| Provider Name | Erica Travonya Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902342322 PECOS PAC ID: 8022393891 Enrollment ID: I20170316002244 |
| Provider Name | Ashley M Hebert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598115362 PECOS PAC ID: 8123392537 Enrollment ID: I20170925000914 |
| Provider Name | Parker Benjamin Jones |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699185579 PECOS PAC ID: 7113200767 Enrollment ID: I20181108002673 |
| Provider Name | Jessa Derania |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1285083550 PECOS PAC ID: 7618302050 Enrollment ID: I20200114000537 |
| Provider Name | Jennifer Davison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720434095 PECOS PAC ID: 4183053663 Enrollment ID: I20200403002137 |
| Provider Name | Ryan Michael Kelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346855517 PECOS PAC ID: 4183044480 Enrollment ID: I20201026000500 |
| Provider Name | Sauntrice O'quin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194246686 PECOS PAC ID: 3870850563 Enrollment ID: I20201118000548 |
| Provider Name | Wendell Perry Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477950434 PECOS PAC ID: 0042622771 Enrollment ID: I20201222000124 |
| Provider Name | Darria Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841882875 PECOS PAC ID: 6103235817 Enrollment ID: I20220329001643 |
| Provider Name | Ashley D Navarre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376257006 PECOS PAC ID: 6901242973 Enrollment ID: I20240422001718 |
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