Healthcare Provider Details

I. General information

NPI: 1275963167
Provider Name (Legal Business Name): KELLI DOOLEY DAVID APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 10/25/2024
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10273 GOULD DRIVE
ST. FRANCISVILLE LA
70775
US

IV. Provider business mailing address

PO BOX 368 - OAK BUILDING
ST. FRANCISVILLE LA
70775
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-9065
  • Fax: 225-635-9069
Mailing address:
  • Phone: 225-635-9065
  • Fax: 225-635-9069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN124785
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP07683
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: