Healthcare Provider Details

I. General information

NPI: 1245627959
Provider Name (Legal Business Name): KELSEY ESCHETTE CST,CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELSEY ESCHETTE PIERCE CST,CSFA

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 PENDLETON DR
HOUMA LA
70360-3929
US

IV. Provider business mailing address

203 PENDLETON DR
HOUMA LA
70360-3929
US

V. Phone/Fax

Practice location:
  • Phone: 985-805-0921
  • Fax:
Mailing address:
  • Phone: 985-805-0921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number140601
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number140601
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: