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NPI Code Detail

MEDICARE: KIESHIA M DOHERTY

MEDICARE: KIESHIA M DOHERTY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1376031740
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIESHIA M DOHERTY
Provider Business Mailing Address
First Line : PO BOX 45698
Second Line :
City : BATON ROUGE
State : LA
Zip : 70895-4698
Country : US
Telephone Number : 225-924-9164
Fax Number :
Provider Business Practice Location Address
First Line : 7569 E INDUSTRIAL DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-7518
Country : US
Telephone Number : 225-924-9164
Fax Number : 225-924-5479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2018
Last Update Date : 05/01/2018

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Directions to “ KIESHIA M DOHERTY ” Practice Location

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