Healthcare Provider Details

I. General information

NPI: 1124547708
Provider Name (Legal Business Name): KENDRA RHAELANA WEBSTER-TAYLOR LMSW, LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA RHAELANA WEBSTER LMSW, LPN

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3683 S FIRST ST
JENA LA
71342-6409
US

IV. Provider business mailing address

PO BOX 317
JENA LA
71342-0317
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-2263
  • Fax:
Mailing address:
  • Phone: 318-758-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number20180634
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10549
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: