Healthcare Provider Details

I. General information

NPI: 1366367880
Provider Name (Legal Business Name): KELLI BRAUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GARDENIA DR
COVINGTON LA
70433-9194
US

IV. Provider business mailing address

1202 S TYLER ST
COVINGTON LA
70433-2330
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-5938
  • Fax:
Mailing address:
  • Phone: 985-871-5983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2288
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: