Healthcare Provider Details

I. General information

NPI: 1962049320
Provider Name (Legal Business Name): KELBY FRIDAY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 E WHATLEY RD
OAKDALE LA
71463-2318
US

IV. Provider business mailing address

12241 HIGHWAY 112
ELIZABETH LA
70638
US

V. Phone/Fax

Practice location:
  • Phone: 318-335-4070
  • Fax:
Mailing address:
  • Phone: 318-623-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN158940
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: