Healthcare Provider Details

I. General information

NPI: 1932023785
Provider Name (Legal Business Name): KAISHELL MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42124 VETERANS AVE
HAMMOND LA
70403-1427
US

IV. Provider business mailing address

48240 WOODHAVEN RD
TICKFAW LA
70466-3511
US

V. Phone/Fax

Practice location:
  • Phone: 985-500-3240
  • Fax:
Mailing address:
  • Phone: 985-507-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: