Healthcare Provider Details

I. General information

NPI: 1780321463
Provider Name (Legal Business Name): KATALYNN CREEL BADEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 BLUEBONNET BLVD
BATON ROUGE LA
70809-3084
US

IV. Provider business mailing address

5045 BLUEBONNET BLVD
BATON ROUGE LA
70809-3084
US

V. Phone/Fax

Practice location:
  • Phone: 225-328-0836
  • Fax:
Mailing address:
  • Phone: 225-328-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225980
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN126301
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: