=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326295239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDRA B. MECHE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2008
-----------------------------------------------------
Last Update Date | 04/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4345 NELSON RD STE 102
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70605-4183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-480-7900
-----------------------------------------------------
Fax | 337-602-6358
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 123594 DEPT 3594
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75312-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-494-2921
-----------------------------------------------------
Fax | 337-494-6523
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 99304-5479
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------