Healthcare Provider Details

I. General information

NPI: 1700164290
Provider Name (Legal Business Name): KARA LEIGH BABAZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA LEIGH SHULL

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5724
US

IV. Provider business mailing address

501 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5724
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-8400
  • Fax: 337-312-6711
Mailing address:
  • Phone: 337-312-8360
  • Fax: 337-312-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP06605
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: