MEDICARE: KENNY HOUSTON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1831569144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY HOUSTON

Provider Business Mailing Address
First Line	:	5610 BUNCOMBE RD APT 113
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-2686
Country	:	US
Telephone Number	:	318-489-0781
Fax Number	:

Provider Business Practice Location Address
First Line	:	3084 WESTFORK DR STE C
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2254
Country	:	US
Telephone Number	:	318-489-0781
Fax Number	:

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

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	06/26/2024

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Directions to “ KENNY HOUSTON ” Practice Location

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