Healthcare Provider Details

I. General information

NPI: 1205315157
Provider Name (Legal Business Name): BRENDA FAYE CAUSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2018
Last Update Date: 08/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35103 OLLIE DEDON RD
KENTWOOD LA
70444-5527
US

IV. Provider business mailing address

PO BOX 567
TANGIPAHOA LA
70465-0567
US

V. Phone/Fax

Practice location:
  • Phone: 985-514-5320
  • Fax:
Mailing address:
  • Phone: 985-514-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: