Healthcare Provider Details

I. General information

NPI: 1952882268
Provider Name (Legal Business Name): K&R PRIORITY TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5467 WATERFORD LN
SORRENTO LA
70778-3437
US

IV. Provider business mailing address

5467 WATERFORD LN
SORRENTO LA
70778-3437
US

V. Phone/Fax

Practice location:
  • Phone: 225-450-2319
  • Fax:
Mailing address:
  • Phone: 225-450-2319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberA821492
License Number StateLA

VIII. Authorized Official

Name: MRS. KOURTNEY DESHA CLAIBORNE
Title or Position: MANAGER
Credential:
Phone: 225-390-6322