Healthcare Provider Details

I. General information

NPI: 1780014779
Provider Name (Legal Business Name): KIRA KANA CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 COOLIDGE ST STE B
LAFAYETTE LA
70503-2309
US

IV. Provider business mailing address

803 S MORGAN AVE
BROUSSARD LA
70518-4921
US

V. Phone/Fax

Practice location:
  • Phone: 337-412-4373
  • Fax: 208-246-4347
Mailing address:
  • Phone: 337-453-4346
  • Fax: 337-735-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMDW.200008
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: