MEDICARE: KA'DEA WADE-GEORGE FNP

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	219392	LA

General Provider Information

NPI Number	:	1396413274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KA'DEA WADE-GEORGE FNP

Provider Business Mailing Address
First Line	:	2000 OPELOUSAS ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-2641
Country	:	US
Telephone Number	:	337-439-9983
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 COMMON ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-6135
Country	:	US
Telephone Number	:	337-439-5861
Fax Number	:

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

Provider Enumeration Date	:	09/03/2021
Last Update Date	:	11/28/2025

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