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NPI Code Detail

MEDICARE: KENNETH TRAHAN

MEDICARE: KENNETH TRAHAN
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
12255A2300XAthletic TrainerJ00331LA

General Provider Information

NPI Number : 1477292589
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH TRAHAN
Provider Business Mailing Address
First Line : 833 LEE DR
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-8123
Country : US
Telephone Number : 985-981-1466
Fax Number :
Provider Business Practice Location Address
First Line : 833 LEE DR
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-8123
Country : US
Telephone Number : 985-981-1466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2022
Last Update Date : 05/27/2022

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Directions to “ KENNETH TRAHAN ” Practice Location

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