Healthcare Provider Details

I. General information

NPI: 1306776166
Provider Name (Legal Business Name): KARLI NICOLE AUGUSTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 ARCENEAUX RD
CARENCRO LA
70520-6220
US

IV. Provider business mailing address

152 KINGSPOINTE CIR
LAFAYETTE LA
70508-4233
US

V. Phone/Fax

Practice location:
  • Phone: 337-896-3267
  • Fax:
Mailing address:
  • Phone: 318-290-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberLA7777
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: