MEDICARE: KELSEY KATE IDOM DPT

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	225100000X	Physical Therapist	11173	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11173	OTHER	LA	LOUISIANA BOARD OF PHYSICAL THERAPY

General Provider Information

NPI Number	:	1346976032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY KATE IDOM DPT

Provider Business Mailing Address
First Line	:	206 HENDERSON RD
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-9409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4624 CYPRESS ST STE 8
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-1348
Country	:	US
Telephone Number	:	318-654-7439
Fax Number	:

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

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	04/30/2025

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1689529745 — TIMARIE ELISABETH DELONY
Practice Location Address:

4624 CYPRESS ST STE 8
WEST MONROE, LA
71291-1348

Practice Phone: 318-654-7439
Practice Fax: 877-221-0259

1144652181 — JOANIE LYNN GRAVES APRN
Practice Location Address:

206 BELL LANE , SUITE C & D
WEST MONROE, LA
71291-1348

Practice Phone: 318-310-5840
Practice Fax:

1063895175 — NATALIE DEMOSS APRN-CPNP
Practice Location Address:

4624 CYPRESS ST STE 7
WEST MONROE, LA
71291-1348

Practice Phone: 318-512-4112
Practice Fax: 318-570-5903

1639617103 — LIL SPROUTS PEDIATRICS & FAMILY CLINIC LLC
Practice Location Address:

206 BELL LANE , STE C & D
WEST MONROE, LA
71291-1348

Practice Phone: 318-310-5840
Practice Fax:

1982486395 — PEGASUS PRIMARY PROVIDERS, LLC
Practice Location Address:

4624 CYPRESS ST STE 7
WEST MONROE, LA
71291-1348

Practice Phone: 318-325-6200
Practice Fax: 318-998-7348

Directions to “ KELSEY KATE IDOM DPT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.