Healthcare Provider Details

I. General information

NPI: 1407688427
Provider Name (Legal Business Name): MRS. KIARA SHAREL FAVORITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 CORPORATE BLVD STE 820
BATON ROUGE LA
70809-1193
US

IV. Provider business mailing address

7425 CORPORATE BLVD STE 820
BATON ROUGE LA
70809-1193
US

V. Phone/Fax

Practice location:
  • Phone: 225-778-8664
  • Fax:
Mailing address:
  • Phone: 225-778-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239757
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159156
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: