Healthcare Provider Details

I. General information

NPI: 1679967368
Provider Name (Legal Business Name): ANDREA KALEENA GEORGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 AMBASSADOR CAFFERY PKWY STE 305
LAFAYETTE LA
70508-7266
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: 225-526-0010
  • Fax: 225-765-9298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200803
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: