Healthcare Provider Details

I. General information

NPI: 1326788506
Provider Name (Legal Business Name): KENDRA CALAIS-KELLY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 ALBERTSON PKWY
BROUSSARD LA
70518-4968
US

IV. Provider business mailing address

102 ISLAND NEST CV
CARENCRO LA
70520-5856
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-6444
  • Fax:
Mailing address:
  • Phone: 504-905-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number224679
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: