=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598604563
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENT J CHERAMIE JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2026
-----------------------------------------------------
Last Update Date | 03/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 GRAVIER ST
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70112-2272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-568-4808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 966 OAK AVE
-----------------------------------------------------
City | HARAHAN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70123-3039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-415-4281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LS0200X
-----------------------------------------------------
Taxonomy Name | School Nurse Practitioner
-----------------------------------------------------
License Number | 222452
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------