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General NPI Number Information
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NPI Number | 1891309001
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Entity Type | Individual
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Provider Name | KATHY JEAN WALES RN
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 13964 GUY ST
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City | WALKER
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State | LA
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Zip | 70785-8035
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Country | US
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Telephone | 225-939-7750
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Fax | 225-686-3082
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Provider Business Mailing Address
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Address Line | PO BOX 1130
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City | LIVINGSTON
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State | LA
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Zip | 70754-1130
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Country | US
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Telephone | 225-686-7044
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Fax | 225-686-3052
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 053141
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License Number State | LA
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