Healthcare Provider Details

I. General information

NPI: 1750735569
Provider Name (Legal Business Name): KATHERINE VICTORIA AYO-RAYBURN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13322 HIGHWAY 90 STE J
BOUTTE LA
70039-3010
US

IV. Provider business mailing address

13322 HIGHWAY 90 STE J
BOUTTE LA
70039-3010
US

V. Phone/Fax

Practice location:
  • Phone: 985-338-2802
  • Fax:
Mailing address:
  • Phone: 985-338-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11018608A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number322309
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: