=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285180968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLIN THEVIS PHARM.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2016
-----------------------------------------------------
Last Update Date | 04/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 PARK CENTER DR
-----------------------------------------------------
City | BROUSSARD
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70518-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-330-2589
-----------------------------------------------------
Fax | 337-252-1100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 PARK CENTER DR
-----------------------------------------------------
City | BROUSSARD
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70518-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-330-2589
-----------------------------------------------------
Fax | 337-252-1100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 021691
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------