Healthcare Provider Details

I. General information

NPI: 1033771233
Provider Name (Legal Business Name): DEBORAH KAGLEAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9345 FLORIDA BLVD
BATON ROUGE LA
70815-1122
US

IV. Provider business mailing address

9345 FLORIDA BLVD
BATON ROUGE LA
70815-1122
US

V. Phone/Fax

Practice location:
  • Phone: 225-315-2152
  • Fax: 225-923-3559
Mailing address:
  • Phone: 225-315-2152
  • Fax: 225-923-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: