Healthcare Provider Details

I. General information

NPI: 1801651310
Provider Name (Legal Business Name): KAYLA B KINNEBREW PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 DELAWARE ST
SHREVEPORT LA
71106-1634
US

IV. Provider business mailing address

670 ALBEMARLE DR BLDG 7
SHREVEPORT LA
71106-5945
US

V. Phone/Fax

Practice location:
  • Phone: 318-730-8060
  • Fax:
Mailing address:
  • Phone: 318-562-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number242633
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN144989
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: