Healthcare Provider Details

I. General information

NPI: 1730792870
Provider Name (Legal Business Name): DAVIDRA KABA APRN, PMHNP-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 HOWELL BLVD STE 100
BATON ROUGE LA
70807-5256
US

IV. Provider business mailing address

7855 HOWELL BLVD STE 100
BATON ROUGE LA
70807-5256
US

V. Phone/Fax

Practice location:
  • Phone: 225-465-8104
  • Fax: 949-703-7057
Mailing address:
  • Phone: 225-465-8104
  • Fax: 949-703-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number219005
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: