Healthcare Provider Details

I. General information

NPI: 1316602642
Provider Name (Legal Business Name): KAYLA KENDGIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WILSON ST
DERIDDER LA
70634-3823
US

IV. Provider business mailing address

6729 CLYBURN LOOP APT B
FORT POLK LA
71459-7233
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-3292
  • Fax:
Mailing address:
  • Phone: 337-378-3214
  • Fax: 337-378-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: