MEDICARE: DR. KELLY L. BAQUET APRN

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	222196	LA

General Provider Information

NPI Number	:	1063031110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY L. BAQUET APRN

Provider Business Mailing Address
First Line	:	2538 DREUX AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-5166
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4636 S CLAIBORNE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70125-5010
Country	:	US
Telephone Number	:	504-897-9200
Fax Number	:

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

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	08/25/2023

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