Healthcare Provider Details

I. General information

NPI: 1053742882
Provider Name (Legal Business Name): NOLA PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 DRIFTWOOD BLVD
KENNER LA
70065-3574
US

IV. Provider business mailing address

2124 DRIFTWOOD BLVD
KENNER LA
70065-3574
US

V. Phone/Fax

Practice location:
  • Phone: 504-468-8585
  • Fax: 504-468-8584
Mailing address:
  • Phone: 504-468-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number2203781882
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: MS. CASEY M SHOOK
Title or Position: DIRECTOR OF NURSING
Credential:
Phone: 504-468-8585