Healthcare Provider Details

I. General information

NPI: 1013419779
Provider Name (Legal Business Name): KATIE DENNIS, M.D. A.P.M.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 AMBASSADOR CAFFERY PKWY STE 410
LAFAYETTE LA
70508-8802
US

IV. Provider business mailing address

4809 AMBASSADOR CAFFERY PKWY STE 410
LAFAYETTE LA
70508-8802
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-3335
  • Fax: 337-504-4735
Mailing address:
  • Phone: 337-504-3335
  • Fax: 337-504-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number304171
License Number StateLA

VIII. Authorized Official

Name: CATHERINE BEAULLIEU
Title or Position: ADMINSTRATOR
Credential:
Phone: 337-504-3335