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NPI Code Detail

MEDICARE: STABLE WATERS LLC

MEDICARE: STABLE WATERS 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1851222475
Entity Type Code : Organization
Provider Name (Legal Business Name) : STABLE WATERS LLC
Provider Business Mailing Address
First Line : 407 BOZEMAN TRL
Second Line :
City : SCOTT
State : LA
Zip : 70583-4259
Country : US
Telephone Number : 504-905-4359
Fax Number :
Provider Business Practice Location Address
First Line : 420 ALBERTSON PKWY
Second Line :
City : BROUSSARD
State : LA
Zip : 70518-4968
Country : US
Telephone Number : 504-905-4359
Fax Number :
Authorized Official
Title or Position : PMHNP, SOLE OWNER
Name : KENDRA A CALAIS-KELLY
Credential : PMHNP
Telephone Number : 504-905-4359
Provider Enumeration Date : 05/25/2026
Last Update Date : 05/25/2026

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Directions to “STABLE WATERS LLC ” Practice Location

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