Healthcare Provider Details

I. General information

NPI: 1669112850
Provider Name (Legal Business Name): KIZZY BREAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 LARIMER ST APT D
LAFAYETTE LA
70506-7910
US

IV. Provider business mailing address

203 LARIMER ST APT D
LAFAYETTE LA
70506-7910
US

V. Phone/Fax

Practice location:
  • Phone: 337-278-7470
  • Fax: 833-411-2118
Mailing address:
  • Phone: 337-278-7470
  • Fax: 833-411-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: