Healthcare Provider Details

I. General information

NPI: 1154634111
Provider Name (Legal Business Name): KAWANDER PARQUET FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 MILLING AVE
LULING LA
70070-4442
US

IV. Provider business mailing address

843 MILLING AVE
LULING LA
70070-4442
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-5852
  • Fax: 985-785-5811
Mailing address:
  • Phone: 985-785-5800
  • Fax: 985-785-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number06139
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: