Healthcare Provider Details

I. General information

NPI: 1730042433
Provider Name (Legal Business Name): KAILYN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 FRANKLIN AVE
GRETNA LA
70053-2115
US

IV. Provider business mailing address

4732 LYNHUBER DR
NEW ORLEANS LA
70126-3920
US

V. Phone/Fax

Practice location:
  • Phone: 504-203-7376
  • Fax: 504-336-3180
Mailing address:
  • Phone: 504-914-1412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: