MEDICARE: LAKEN DESONIER KELLY N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP08194	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033502497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKEN DESONIER KELLY N.P.

Provider Business Mailing Address
First Line	:	3649 S BEGLIS PKWY
Second Line	:	3645 S. BEGLIS PKWY
City	:	SULPHUR
State	:	LA
Zip	:	70665-8107
Country	:	US
Telephone Number	:	337-476-3149
Fax Number	:

Provider Business Practice Location Address
First Line	:	3649 S BEGLIS PKWY
Second Line	:	3645 S. BEGLIS PKWY
City	:	SULPHUR
State	:	LA
Zip	:	70665-8107
Country	:	US
Telephone Number	:	337-476-3149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	12/01/2016

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