Healthcare Provider Details

I. General information

NPI: 1518746098
Provider Name (Legal Business Name): KELLI M DUCOTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 AMBASSADOR CAFFERY PKWY STE 401A
LAFAYETTE LA
70508-7265
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-3040
  • Fax: 337-470-3052
Mailing address:
  • Phone: 337-470-3040
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number232270
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number232270
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: