MEDICARE: KH HEALTHCARE SERVICES LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1427575711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KH HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	70380 HWY 21 SUITE 2 PMB 170
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433
Country	:	US
Telephone Number	:	985-792-8977
Fax Number	:	985-790-7090

Provider Business Practice Location Address
First Line	:	101 ASHLAND WAY
Second Line	:
City	:	MADISONVILLE
State	:	LA
Zip	:	70447-3357
Country	:	US
Telephone Number	:	985-792-8977
Fax Number	:	985-790-7090

Authorized Official
Title or Position	:	OWNER
Name	:	KELA SPIKES BICKHAM
Credential	:	DNP
Telephone Number	:	985-792-8977

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	08/28/2017

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Directions to “KH HEALTHCARE SERVICES LLC ” Practice Location

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