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General NPI Number Information
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NPI Number | 1548764327
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Entity Type | Individual
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Provider Name | KELSEY HERSHEY MANGUNO MD
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Gender | Female
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 5025 KEYSTONE BLVD STE 100
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City | COVINGTON
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State | LA
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Zip | 70433-7526
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Country | US
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Telephone | 985-893-3395
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Fax | 985-892-8212
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Provider Business Mailing Address
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Address Line | 200 HENRY CLAY AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70118-5720
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Country | US
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Telephone | 504-894-6783
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 326106
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License Number State | LA
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