Healthcare Provider Details

I. General information

NPI: 1033806922
Provider Name (Legal Business Name): KERA CAZELOT WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERA BORDELON DAUZAT WHNP

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 HIGHWAY 1192
MARKSVILLE LA
71351-4711
US

IV. Provider business mailing address

4231 HIGHWAY 1192
MARKSVILLE LA
71351-4711
US

V. Phone/Fax

Practice location:
  • Phone: 318-240-6000
  • Fax: 318-240-6077
Mailing address:
  • Phone: 318-253-6000
  • Fax: 318-240-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number229817
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: