Healthcare Provider Details

I. General information

NPI: 1700444288
Provider Name (Legal Business Name): KATIE SUMMERELL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 KAFFIE DR
NATCHITOCHES LA
71457-5018
US

IV. Provider business mailing address

305 S HIGHLAND DR
MANY LA
71449-3719
US

V. Phone/Fax

Practice location:
  • Phone: 866-484-8049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8126
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: