Healthcare Provider Details

I. General information

NPI: 1255108650
Provider Name (Legal Business Name): CAITLYN MARIE KUDRECKI PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E NAPOLEON ST
SULPHUR LA
70663-3707
US

IV. Provider business mailing address

2651 E NAPOLEON ST
SULPHUR LA
70663-3707
US

V. Phone/Fax

Practice location:
  • Phone: 337-625-6750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC8728
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: