Healthcare Provider Details

I. General information

NPI: 1134864366
Provider Name (Legal Business Name): KEYUNTA LAKEIL PERKINS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 HIGHWAY 22
MANDEVILLE LA
70471-3310
US

IV. Provider business mailing address

PO BOX 2021
PONCHATOULA LA
70454-2021
US

V. Phone/Fax

Practice location:
  • Phone: 985-626-3470
  • Fax:
Mailing address:
  • Phone: 985-662-2049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224850
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: