Healthcare Provider Details

I. General information

NPI: 1437079324
Provider Name (Legal Business Name): GEORGIA KELLER VERRET PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 CONCORDIA DR
LA PLACE LA
70068-2214
US

IV. Provider business mailing address

2824 CONCORDIA DR
LA PLACE LA
70068-2214
US

V. Phone/Fax

Practice location:
  • Phone: 504-239-0863
  • Fax:
Mailing address:
  • Phone: 504-239-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number227194
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: