Healthcare Provider Details

I. General information

NPI: 1891641718
Provider Name (Legal Business Name): KATIE LYNN CANGIAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MEDICAL CENTER BLVD
MARRERO LA
70072-3147
US

IV. Provider business mailing address

1101 MEDICAL CENTER BLVD
MARRERO LA
70072-3147
US

V. Phone/Fax

Practice location:
  • Phone: 504-347-5511
  • Fax:
Mailing address:
  • Phone: 504-347-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number352552
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: