=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871553008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIM LAVERGNE DAKIN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2006
-----------------------------------------------------
Last Update Date | 04/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1270 ATTAKAPAS DR SUITE 201
-----------------------------------------------------
City | OPELOUSAS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70570-6549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-942-3230
-----------------------------------------------------
Fax | 337-942-1659
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 604 N ACADIA RD STE 101
-----------------------------------------------------
City | THIBODAUX
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70301-4897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-446-5079
-----------------------------------------------------
Fax | 985-447-2497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | MD.021223
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------