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General NPI Number Information
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NPI Number | 1083067144
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Entity Type | Individual
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Provider Name | KEIFFER BENGIE WYBLE AGACNP
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Gender | Male
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 2730 AMBASSADOR CAFFERY PKWY
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City | LAFAYETTE
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State | LA
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Zip | 70506
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Country | US
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Telephone | 337-988-1585
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Fax | 337-981-4694
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Provider Business Mailing Address
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Address Line | 2730 AMBASSADOR CAFFERY PKWY
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City | LAFAYETTE
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State | LA
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Zip | 70506-5939
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Country | US
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Telephone | 337-988-1585
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Fax | 337-981-4694
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP09352
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP09352
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 364SR0400X
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Taxonomy Name | Rehabilitation Clinical Nurse Specialist
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License Number | AP09352
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License Number State | LA
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