Healthcare Provider Details

I. General information

NPI: 1518099282
Provider Name (Legal Business Name): JOANNA KUKUY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HOUMA BLVD SUITE 301
METAIRIE LA
70006-2932
US

IV. Provider business mailing address

4300 HOUMA BLVD SUITE 301
METAIRIE LA
70006-2932
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-3500
  • Fax: 504-455-3006
Mailing address:
  • Phone: 504-455-3500
  • Fax: 504-455-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA10461
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: