Healthcare Provider Details

I. General information

NPI: 1649635806
Provider Name (Legal Business Name): JALEESA KEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W PINHOOK RD STE 201
LAFAYETTE LA
70508-3735
US

IV. Provider business mailing address

449 E SAINT PETER ST
NEW IBERIA LA
70560-3752
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0770
  • Fax:
Mailing address:
  • Phone: 337-321-9204
  • Fax: 337-321-9210

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: