Healthcare Provider Details

I. General information

NPI: 1720474273
Provider Name (Legal Business Name): KATIE A DENNIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 03/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 ENERGY PARKWAY
LAFAYETTE LA
70508-3816
US

IV. Provider business mailing address

206 ENERGY PARKWAY
LAFAYETTE LA
70508-3816
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-3335
  • Fax: 337-504-4795
Mailing address:
  • Phone: 337-504-3335
  • Fax: 337-504-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberINTERN PERMIT PENDIN
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number304171
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: