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General NPI Number Information
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NPI Number | 1073344222
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Entity Type | Individual
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Provider Name | MR. KEVIN JAMES PREJEAN
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Gender | Male
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 439 E SAINT PETER ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-3752
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Country | US
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Telephone | 337-367-5858
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Fax | 337-359-9083
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Provider Business Mailing Address
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Address Line | 439 E SAINT PETER ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-3752
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Country | US
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Telephone | 337-367-5858
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Fax | 337-359-9083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 2203785514
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License Number State | LA
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