Healthcare Provider Details

I. General information

NPI: 1992589626
Provider Name (Legal Business Name): KANNEYA KAY USSIN PEER SUPPORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 TULANE AVE STE 405
NEW ORLEANS LA
70119-7167
US

IV. Provider business mailing address

403 N HULLEN ST
METAIRIE LA
70001-5117
US

V. Phone/Fax

Practice location:
  • Phone: 504-342-4222
  • Fax: 504-342-4225
Mailing address:
  • Phone: 504-875-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberOBHPSS1045
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: