=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225388929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDRA PAUL PATRICK NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2012
-----------------------------------------------------
Last Update Date | 08/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4911 GROOM RD
-----------------------------------------------------
City | BAKER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70714-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-454-3744
-----------------------------------------------------
Fax | 915-296-5612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3009 RAY WEILAND DR UNIT 122
-----------------------------------------------------
City | BAKER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70714-3251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-454-3744
-----------------------------------------------------
Fax | 915-296-5612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP07070
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | AP07070
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP07070
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------