Healthcare Provider Details

I. General information

NPI: 1518312677
Provider Name (Legal Business Name): KACIE STEWART WATTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41676 VETERANS AVE
HAMMOND LA
70403
US

IV. Provider business mailing address

41676 VETERANS AVE
HAMMOND LA
70403-1412
US

V. Phone/Fax

Practice location:
  • Phone: 985-543-3600
  • Fax: 985-542-7571
Mailing address:
  • Phone: 859-543-3600
  • Fax: 985-542-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number311733
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: