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NPI Code Detail

MEDICARE: REBECCA LYNN KIELY

MEDICARE: REBECCA LYNN KIELY
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
1363LF0000XFamily Nurse PractitionerAP10137LA

General Provider Information

NPI Number : 1801382031
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA LYNN KIELY
Provider Business Mailing Address
First Line : 352 C DEES RD
Second Line :
City : DERIDDER
State : LA
Zip : 70634-8949
Country : US
Telephone Number : 337-401-6144
Fax Number :
Provider Business Practice Location Address
First Line : 614 N PINE ST
Second Line :
City : DERIDDER
State : LA
Zip : 70634-3546
Country : US
Telephone Number : 337-462-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2018
Last Update Date : 07/11/2018

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Directions to “ REBECCA LYNN KIELY ” Practice Location

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