Healthcare Provider Details

I. General information

NPI: 1851222475
Provider Name (Legal Business Name): STABLE WATERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 ALBERTSON PKWY
BROUSSARD LA
70518-4968
US

IV. Provider business mailing address

407 BOZEMAN TRL
SCOTT LA
70583-4259
US

V. Phone/Fax

Practice location:
  • Phone: 504-905-4359
  • 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 Number
License Number State

VIII. Authorized Official

Name: KENDRA A CALAIS-KELLY
Title or Position: PMHNP, SOLE OWNER
Credential: PMHNP
Phone: 504-905-4359